It is Is it better to take antihypertensive drugs in the morning or evening? It seems that the right answer is the most unexpected, and that is «when you prefer». This is suggested by the results of the TIME study (Treatment in Morning Evening) presented a few months ago at the congress of the European Society of Cardiology whose results are discussed by Bridget M. Kuehn in a recent article on Circulation.In practice, in the study, taking antihypertensive drugs in the morning or evening did not change the participants’ risk of a cardiovascular event.
As Kuehn explains, the growing interest in the role of circadian rhythms in heart health has led some scientists to assume the usefulness of synchronizing medication intake with this cycle. It has been hypothesized that taking antihypertensives during the evening hours may cause greater effects and some studies have moved in this direction. One in particular, published in 2020 in the European Heart Journal (Hygia Chronotherapy Trial), showed that evening administration of antihypertensives was associated with a decrease in cardiovascular events of 45%. Since its publication, the research has sparked controversy, some of which has led the journal’s editors to produce a «letter of concern» and some industry leaders to argue that physicians should ignore the results.
Now, Kuehn points out, the hope of many scientists is that TIME’s findings will settle the debate over the importance of timing of drug delivery.»TIME was one of the largest cardiovascular studies ever conducted and provides a definitive answer to the question of whether blood pressure-lowering drugs should be taken in the morning or evening,» said Thomas MacDonald, study coordinator. At the same time, Kuehn also reports that the first author of the study Hygia pointed out the important differences between the two studies, both in the patient population considered and in the dosage regimens.
TIME included more than 21,000 hypertensive patients with an average age of 65 who were randomized to take the antihypertensive drug in the morning or evening and then followed for a follow-up of approximately 5 years. There were no statistically significant differences between groups in the proportion of patients who were hospitalized for nonfatal myocardial infarction, nonfatal stroke or death from vascular causes (which occurred in 3.7% of the group that took the drug in the morning and in 3.4% of those who took it in the evening).There were also no differences in the analyses of some subgroups, such as the one that included patients with diabetes. Evening administration of the drugs also did not lead to an increased risk of falls, fractures and other adverse events, an aspect feared by the authors, who were concerned that nocturnal hypotension could affect patients who go to the bathroom during the night.
The research did not stop there and continues to collect subjects to analyze. Two studies are underway in Canada that will provide further information on the issue.
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Source — https://www.univadis.it/viewarticle/l%25E2%2580%2599ora-giusta-l%25E2%2580%2599antipertensivo-2023a10003ic