BACKGROUND AND PURPOSE:

• Some studies support bedtime vs morning administration of BP medications to reduce cardiovascular risk, but evidence is inconsistent
• Garrison et al. (JAMA, 2025) sought to determine the effect of bedtime vs morning administration of antihypertensive medications on major cardiovascular events and death

METHODS:

• Multicenter, open-label, pragmatic randomized clinical trial with blinded end-point assessment
  • BedMed Randomized Clinical Trial
  • Recruited through 436 primary care clinicians in 5 Canadian provinces  
• Participants
  • Community-dwelling adult patients with hypertension
  • Taking ≥1 once-daily antihypertensive medication
• Interventions
  • Using all once-daily antihypertensive medications at bedtime
  • Using all in the morning
• Primary outcome
  • Composite of time to first occurrence of
    • All-cause death or hospitalization/ED visit for stroke | Acute coronary syndrome | Heart failure
• Secondary outcomes
  • All-cause unplanned hospitalizations/ED visits
  • Safety outcomes
    • Visual | Cognitive | Fall- and/or fracture-related

RESULTS:

• Bedtime: 1677 participants | Morning: 1680 participants
  • Female: 56.4% | Median age: 67 years
  • Monotherapy: 53.7%
  • Median follow-up: 4.6 years
• There was no difference in the rate of the primary outcome between the bedtime and morning groups
  • Bedtime: 2.3 per 100 patient-years | Morning: 2.4 per 100 patient-years
  • Adjusted hazard ratio (aHR) 0.96 (95% CI, 0.77 to 1.19) | P=0.70
• Additionally, there was also no difference in
  • Individual components of the primary outcome
  • All-cause hospitalizations/ED visits
  • Safety outcomes
    • Falls/fractures | Glaucoma diagnoses | 18-month cognitive decline

CONCLUSION:

• For adults receiving antihypertensive medications in primary care, taking once-daily medications at bedtime was safe but did not reduce cardiovascular risk compared to taking medication in the morning
• The authors state

Antihypertensive medication administration time did not affect the risks and benefits of BP-lowering medication and instead should be guided by patient preferences

Learn More – Primary Sources:

Antihypertensive Medication Timing and Cardiovascular Events and Death: The BedMed Randomized Clinical Trial

BedMed – Pragmatic Trials Collaborative