The Hygia Chronotherapy Trial, recently conducted in Spain, has assessed the effect of the timing of hypertension therapy upon cardiovascular disease (CVD) risk reduction. The multi-centre, controlled, prospective trial included 19,084 hypertensive patients (mean age 60.5 ± 13.7 years) who were instructed to ingest the entire daily dose of ≥1 prescribed BP-lowering medications either at bedtime (n=9552) or upon awakening (n=9532). Ambulatory blood pressure (ABP) monitoring was implemented for 48 hours at inclusion and at every clinic visit (at least annually). Median patient follow-up was 6.3 years and the primary CVD outcome (CVD death, myocardial infarction, coronary revascularisation, heart failure or stroke) was observed in 1,752 patients during this period. Patients taking hypertension medications at bedtime had a significantly lower adjusted hazard ratio of the primary CVD outcome compared to those taking the medications upon awakening [0.55 (95% CI 0.50–0.61), P<0.001]. In addition, adjusted hazard ratios were significantly lower for patients taking medications at bedtime in each component of the primary outcome (P<0.001 for all):

  • CVD death [0.44 (0.34–0.56)]
  • Myocardial infarction [0.66 (0.52–0.84)]
  • Coronary revascularisation [0.60 (0.47–0.75)]
  • Heart failure [0.58 (0.49–0.70)]
  • Stroke [0.58 (0.49–0.70)]

From these results, it was concluded that routine use of ≥1 prescribed BP-lowering medications at bedtime resulted in significantly enhanced BP control and significantly decreased morbidity and mortality related to CVD events. The full details of the study, published in the European Heart Journal, can be accessed here.

Contributed by Australian Medication Safety Services Associate – Isabella Singh