Bedtime antihypertensive dosing was associated with lower adjusted two-month BP and greater target attainment than morning dosing in 60 patients with nondipping hypertension, but change-based (median) estimates were less precise, indicating uncertainty about the distribution of response; these exploratory findings from a small randomized trial warrant prospective confirmation.
Bedtime dosing was associated with substantially lower baseline-adjusted two-month systolic BP than morning dosing.
Bedtime dosing was also associated with lower adjusted diastolic BP and mean arterial pressure.
Bootstrap confidence intervals for the adjusted differences were similar to the parametric ANCOVA intervals.
Far more patients reached the BP target of <140/90 mmHg with bedtime dosing than with morning dosing.
Change-based estimates (median changes from baseline) were less precise, with confidence intervals that included zero.
The study was a post hoc secondary analysis of a small randomized trial, and the authors characterize the findings as exploratory requiring prospective confirmation.
This study re-analyzed data from a small randomized trial of 60 people with uncontrolled high blood pressure whose pressure did not drop normally at night ("nondipping"). Half took their blood pressure medication in the morning and half at bedtime. Instead of looking only at average differences, the researchers also looked at how many people reached a target and how individual changes were spread out. After two months, and after accounting for starting blood pressure, the bedtime group had lower readings: about 18 mmHg lower systolic and about 12 mmHg lower diastolic pressure. Nearly all bedtime patients (29 of 30) reached a level below 140/90 mmHg, compared with 3 of 30 in the morning group. However, when the researchers compared the typical (median) amount of change from baseline, the differences were smaller and the statistical uncertainty was wide enough to include no difference. This research suggests that bedtime dosing may help people with nondipping hypertension reach blood pressure targets, but the trial was small and this was an after-the-fact analysis. The mixed picture between the adjusted results and the change-based results means it is not clear how consistently individuals respond. The authors say larger prospective studies are needed to confirm these findings.
Farah R, Bragazzi N, Ceylan H, Ballout N, Hanna T, Khamisy-Farah R. (2026). Beyond Mean Blood Pressure Reduction: Distributional and Responder Effects of Bedtime Antihypertensive Dosing in Nondipping Hypertension. A Secondary Analysis of a Randomized Controlled Study.. Journal of clinical hypertension (Greenwich, Conn.). https://doi.org/10.1111/jch.70372