- Question
- To determine whether taking once-daily antihypertensive medications at bedtime rather than in the morning reduces major cardiovascular events and death.
- Design
- Pragmatic, multicenter, open-label, 1:1 randomized trial with blinded end-point assessment. Recruitment through 436 primary care clinicians in 5 Canadian provinces; 3357 patients followed for a median of 4.6 years.
- Population
- Community-dwelling adults with hypertension taking at least one once-daily antihypertensive medication in primary care. Median age was 67 years, 56.4% were female and 53.7% were on monotherapy.
- Intervention
- All once-daily antihypertensive medications taken at bedtime (n = 1677).
- Control
- All once-daily antihypertensive medications taken in the morning (n = 1680).
- Primary outcome
- Time to first occurrence of all-cause death or hospitalization/emergency department visit for stroke, acute coronary syndrome, or heart failure.
- Results
- The primary outcome occurred at a rate of 2.3 per 100 patient-years in the bedtime group and 2.4 per 100 patient-years in the morning group (adjusted HR 0.96; 95% CI 0.77-1.19; P = .70). Individual components of the primary outcome and all-cause hospitalizations/ED visits also did not differ between groups.
- Safety
- There were no differences in falls or fractures, new glaucoma diagnoses, or 18-month cognitive decline.
- Conclusion
- Bedtime dosing of antihypertensive medications was safe but did not reduce cardiovascular risk compared with morning dosing.
- Why it matters
- The trial suggests that dosing time does not change the benefits or risks of blood pressure-lowering therapy, so timing can be guided by patient preference.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026