Open AccessEvening Dosing of Antihypertensive Therapy to Reduce Cardiovascular Events: A Third Type of Evidence Based on a Systematic Review and Meta‐Analysis of Randomized Trials
Author(s) -
Roush George C.,
Fapohunda Jadesola,
Kostis John B.
Publication year - 2014
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12354
Subject(s) - evening , dosing , medicine , meta analysis , morning , relative risk , blood pressure , randomized controlled trial , clinical trial , confidence interval , physics , astronomy
Nighttime blood pressure strongly predicts cardiovascular events ( CVE s). Further, a preliminary trial has shown decreased CVE s from evening vs morning dosing of antihypertensive therapy. Is there additional evidence for evening dosing? The authors systematically classified all hypertension trials as evening dosing trials ( EDT s) or usual dosing trials ( UDT s). Meta‐analyses provided standardized hazard ratios for CVE s for EDT s ( HR EDT s ) and UDT s ( HR UDT s ). HR EDT s / HR UDT s gave the relative risk ( RR ) from evening vs usual dosing. Among 175 trials, 5 EDT s were discovered. The RR for CVE s (95% confidence limits) from evening vs usual dosing was 0.63 (0.43–0.92; P =.016). After adjustment for drug class, the RR was 0.54 (0.34–0.85; P =.008). Unlike other EDT s, the Heart Outcomes Prevention Evaluation ( HOPE ) study administered its entire antihypertensive dose prior to sleep and gave the greatest risk reduction. This study provides a third type of evidence suggesting a beneficial effect from evening dosing of antihypertensive therapy. Head‐to‐head, multicenter trials are needed to test this strategy.