Nighttime Dosing May Provide Better Blood Pressure Control

TOPLINE:

Bedtime administration of olmesartan-amlodipine provided better control of nocturnal blood pressure (BP) with a 3.0 mm Hg greater reduction in nighttime systolic pressure than morning dosing, without increasing the risk for nocturnal hypotension.

METHODOLOGY:

• Researchers conducted a multicenter randomized clinical trial of 720 patients (mean age, 55.5 years; 409 men) with hypertension at 15 hospitals in China between June 2022 and April 2024.
• Participants were assigned to receive olmesartan (20 mg) and amlodipine (5 mg) as a single pill either in the morning (6-10 AM; n = 352) or at bedtime (6-10 PM; n = 368) for 12 weeks.
• The primary outcome was the change in nighttime systolic BP from baseline to 12 weeks, with dosage adjustments based on ambulatory and office BP measurements at weeks 4 and 8.
• The researchers conducted both intention-to-treat and per-protocol analyses, with 607 patients (84.3%) completing the 12-week follow-up.

TAKEAWAY:

• Patients in the bedtime dosing group showed significantly greater reductions in nighttime systolic BP (between-group difference, -3.0 mm Hg; 95% CI, -5.1 to -1.0 mm Hg; P = .004).
• Nocturnal systolic BP control rates were higher in the bedtime dosing group (79.0% vs 69.8%; P = .01), with improved circadian rhythm and no difference in nocturnal hypotension incidence.
• The bedtime dosing group required less medication titration with 52.7% of patients compared with 61.5% of those in the morning group receiving increased dosage at week 4 (P = .02).
• Morning systolic BP showed greater reduction in the bedtime group (between-group difference, -3.1 mm Hg; 95% CI, -5.6 to -0.5 mm Hg) without compromising 24-hour BP control.

IN PRACTICE:

“In this randomized clinical trial of antihypertensive chronotherapy, bedtime dosing provided better control of nocturnal blood pressure and improved the circadian rhythm, without reducing the efficacy on mean daytime or 24-hour blood pressure, or increasing the risk of nocturnal hypotension. These findings support the potential advantages of bedtime administration and offer new evidence to guide future research on antihypertensive chronotherapy,” the researchers reported.

SOURCE:

This study was led by Runyu Ye, PhD, of Sichuan University in Chengdu, China. It was published online on July 9 in JAMA Network Open.

LIMITATIONS:

This study included only Chinese participants without cardiovascular disease, limiting the generalizability to other ethnic populations or patients with cardiovascular conditions. The lack of widespread availability of ambulatory blood pressure monitoring in clinical practice and its limited use in outcome trials for medication titration also may restrict the broader application of findings. Participant-reported adherence to dosing timing could introduce measurement error.

DISCLOSURES:

This study was funded by grants from the Nanjing Chia Tai Tianqing Pharmaceutical Co Ltd, the Science and Technology Program of Tibet Autonomous Region, and the Sichuan Natural Science Foundation Project. The funders had no role in the design, conduct, analysis, manuscript preparation, or publication decisions.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.