Abstract 16765: Association of Evening or Bedtime Dosing of Antihypertensive Medications With Nighttime Blood Pressure and Cardiovascular Prognoses

Abstract

Introduction: Previous studies suggested that bedtime use of antihypertensive medications does not improve cardiovascular outcomes. However, there is a few studies reporting the association of bedtime dosing of antihypertensives with nighttime blood pressure (BP) and cardiovascular prognoses. Hypothesis: Evening/bedtime dosing of antihypertensives may improve cardiovascular outcomes through reductions in nocturnal BP. Methods: We used the dataset of nationwide prospective, the Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study to assess the association of evening/bedtime dosing with nighttime BP and cardiovascular prognoses. Among whole 6,359 participants underwent 24h ambulatory BP monitoring, participants with pre-history of cardiovascular disease and not use antihypertensives were excluded in this analysis. Evening or bedtime and two occasions (morning and evening/bedtime) use of antihypertensives were defined as the group of evening/bedtime dosing. Results: Among 4,085 participants (69.1 years and 45% of male), there was no difference between the group of evening/bedtime and morning/others dosing in 24h systolic BP (SBP) (132.9±14.2 vs. 132.0±14.0, p=0.086). Nighttime SBP was higher in evening/bedtime dosing (123.1±17.5 vs. 121.4±16.8, p=0.004). During the median 4.9-years followed-up, 150 cardiovascular events (coronary artery disease, stroke, heart failure) occurred. The evening/bedtime dosing was not associated with cardiovascular events risk adjusted by 24h ambulatory BP (adjusted HR [95%CI], 1.11 [0.78-1.57]) or nighttime BP (Figure). In stratified analysis of participants with or without nocturnal hypertension (nighttime SBP≥120 mmHg or diastolic BP≥70 mmHg), evening/bedtime dosing was also not associated with cardiovascular outcomes. Conclusions: Our study suggested that evening/bedtime dosing of antihypertensives did not give benefit for nighttime BP control and cardiovascular prognoses.