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Meta-Analysis
. 2014 Aug;16(8):561-8.
doi: 10.1111/jch.12354. Epub 2014 Jul 16.

Evening dosing of antihypertensive therapy to reduce cardiovascular events: a third type of evidence based on a systematic review and meta-analysis of randomized trials

George C Roush  1 , Jadesola Fapohunda, John B Kostis
Affiliations
Meta-Analysis

Evening dosing of antihypertensive therapy to reduce cardiovascular events: a third type of evidence based on a systematic review and meta-analysis of randomized trials

George C Roush et al. J Clin Hypertens (Greenwich). 2014 Aug.

Abstract

Nighttime blood pressure strongly predicts cardiovascular events (CVEs). Further, a preliminary trial has shown decreased CVEs from evening vs morning dosing of antihypertensive therapy. Is there additional evidence for evening dosing? The authors systematically classified all hypertension trials as evening dosing trials (EDTs) or usual dosing trials (UDTs). Meta-analyses provided standardized hazard ratios for CVEs for EDTs (HREDT s ) and UDTs (HRUDT s ). HREDT s /HRUDT s gave the relative risk (RR) from evening vs usual dosing. Among 175 trials, 5 EDTs were discovered. The RR for CVEs (95% confidence limits) from evening vs usual dosing was 0.63 (0.43-0.92; P=.016). After adjustment for drug class, the RR was 0.54 (0.34-0.85; P=.008). Unlike other EDTs, the Heart Outcomes Prevention Evaluation (HOPE) study administered its entire antihypertensive dose prior to sleep and gave the greatest risk reduction. This study provides a third type of evidence suggesting a beneficial effect from evening dosing of antihypertensive therapy. Head-to-head, multicenter trials are needed to test this strategy.

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Figures

Figure 1
Figure 1
Number of articles at each step of systematic review beginning with miscellaneous sources, the Cochrane Registry of Randomized Trials, and the PubMed database leading to 13 blood pressure (BP) difference trials and 8 drug comparison trials published from January 1, 2008, to December 31, 2013. These were added to the trials from the systematic review by Law and colleagues,9 which covered trials published from 1967 to December 31, 2007, to yield 121 BP difference trials and 54 drug comparison trials for review.
Figure 2
Figure 2
Relative risks from evening dosing vs usual dosing for coronary artery disease, stroke, and all cardiovascular events. P values are .061, .129, and .016, respectively. IV indicates inverse variance weighting; CI, confidence interval.
Figure 3
Figure 3
Relative risks from evening dosing vs usual dosing for all cardiovascular events within drug classes and the overall relative risk adjusted for drug class. IV indicates inverse variance weighting; CI, confidence interval; ACE, angiotensin‐converting enzyme; CAD, coronary artery disease; CVA, cerebrovascular accident.
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References

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