Abstract 4370122: Day versus Evening Hypertensive medication and risk of Cardiovascular Disease: A Meta-analysis of Randomized Controlled Trials

Abstract

Background: Hypertension significantly contributes to cardiovascular disease. Emerging evidence suggests that evening antihypertensive dosing may better control nocturnal blood pressure and reduce cardiovascular risk. However, randomized controlled trial findings on optimal dosing timing are inconsistent. Objective: This meta-analysis evaluates the impact of morning versus evening antihypertensive medication administration on cardiovascular outcomes. Methods: We performed a systematic literature search on PubMed, Scopus, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inspection until June 4th, 2025. Studies were thought to be eligible for inclusion if patients with hypertension received hypertensive medication with the intervention group during the morning and the control group in the evening. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant. Results: Seven RCTs with 63,333 patients (31,768 patients in morning time, and 31,565 patients in evening medication) were included in the analysis. The mean age of patients was 63 years. Pooled analysis showed that risk of all-cause mortality (OR, 1.09(95%CI: 0.90-1.32), p=0.38), cardiovascular mortality (OR, 2.11(95%CI: 0.63-7.07), p=0.23), heart failure (OR, 1.80(95%CI: 0.85-3.80), p=0.12), myocardial infarction (OR, 1.09(95%CI: 0.92-1.29), p=0.32), stroke (OR, 1.23(95%CI: 0.84-1.79), p=0.28), and MACE (OR, 1.36(95%CI: 1.0-1.85), p=0.050) was comparable between both the groups of patients. Conclusion: This meta-analysis supports the findings of the BEDMED, 2025 trial with no significant differences between the risk of morning versus evening medication of antihypertensive drugs.