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Primary care
Should blood pressure medications be taken at bedtime?
  1. Carl Heneghan1,
  2. Jack O'Sullivan2,
  3. Kamal R Mahtani1
  1. 1 Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Stanford University, Stanford, California, USA
  1. Correspondence to Professor Carl Heneghan, Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK; carl.heneghan{at}

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Hypertension is a common problem that increases cardiovascular risk. A recent large trial suggests the timing of treatment can make a difference to outcomes.

Accumulating evidence shows that the time of day that antihypertensives are taken can impact their effectiveness: taking them at night reduces asleep blood pressure (BP), without compromising their effect on daytime BP.1 Asleep BP is also a better predictor of cardiovascular risk than daytime measurements and non-dipping during sleep, defined as a decline of less than a 10% in systolic pressure, is associated with an increased cardiovascular risk.2

In 2010, a randomised trial including 2156 hypertensives, taking ≥1 BP-lowering medication at bedtime, reported significant reductions in night-time BP and cardiovascular events at a mean 5.6 years of follow-up.3 However, the generalisability of the trial findings was limited by the single-centre design and the small sample size of the study. Replication of these findings in a much larger primary care population was therefore needed.

The Hygia Chronotherapy Trial sought to address this evidence gap. The study randomised 19 084 primary care patients, across a …

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  • Twitter @carlheneghan, @@DrJackOSullivan, @krmahtani

  • Contributors CH wrote the first draft, JO and KRM contributed to further drafts and all authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CH is supported by the NIHR School for Primary Care Research. Evidence Synthesis Working group (NIHR SPCR ESWG project 390). CH isalso supported by the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, an NIHR senior investigator and editor-in-chief of BMJ Evidence-Based Medicine. JO is an NIH Postdoctoral Fellow at Stanford University. He is an associate editor at BMJ Evidence-Based Medicine. KRM is supported by the NIHR School for Primary Care ResearchEvidence Synthesis Working group (NIHR SPCR ESWG project 390).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.