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The effect of taking blood pressure lowering medication at night on cardiovascular disease risk. A systematic review

Journal of Human Hypertension volume 35, pages 308–314 (2021)Cite this article

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Abstract

To investigate the effect of night-time BP-lowering drug treatment on the risk of major CVD and mortality, we systematically reviewed randomized controlled trials comparing night-time versus morning dosing. Two studies were found relevant to the clinical question (the MAPEC and Hygia trials). They were similar in study design and population and were conducted by the same study group. As the Hygia trial had more power with a significantly larger sample size, we did not perform a meta-analysis. Both studies reported a reduction of ~50% in major CVD events and all-cause mortality with night-time dosing and a reduction of 60% in CVD mortality. The results from these studies support the implementation of night-time BP-lowering drug treatment in the prevention of CVD and mortality. However there is an on-going discussion on the validity and methodology of MAPEC and Hygia trials, the interpretation of the results should be cautious. Stronger evidence is needed prior to changing clinical practice. Questions that remain to be answered relate to the generalisability of the results across different populations at different levels of BP related risk and the importance of morning versus evening timing of medication on CVD prevention as determined though a well-designed randomised controlled trial.

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Acknowledgements

The researchers gratefully acknowledge NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement for their support of this project. CMR is supported by a NHMRC Principal Research Fellowship (1136372). We thank Prof Hermida for his kind support on the enquiries related to MAPEC and Hygia trial. We thank Dr Jun Chih (Biostatisticician, School of Public Health, Curtin University) for her advise on statistical issues.

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Authors and Affiliations

  1. School of Public Health, Curtin University, Perth, WA, Australia

    Chau L. B. Ho, Enayet K. Chowdhury & Christopher M. Reid

  2. CCRE Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Enayet K. Chowdhury, Mark R. Nelson & Christopher M. Reid

  3. Centre for Longitudinal and Life Course Research, The University of Queensland, Brisbane, QLD, Australia

    Jenny Doust

  4. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia

    Mark R. Nelson

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Correspondence to Chau L. B. Ho.

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Ho, C.L.B., Chowdhury, E.K., Doust, J. et al. The effect of taking blood pressure lowering medication at night on cardiovascular disease risk. A systematic review. J Hum Hypertens 35, 308–314 (2021). https://doi.org/10.1038/s41371-020-00469-1

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