DOES taking blood pressure medication at bedtime, rather than in the morning, reduce cardiovascular risk? The concept has been debated for years, with some earlier studies suggesting improved outcomes when medications are taken at night. However, concerns have persisted about possible adverse effects such as vision problems or falls during sleep. In a recent trial involving over 3,000 patients with hypertension, researchers that cardiovascular risk remained similar regardless of when medication was taken.
The study was a pragmatic, open-label trial conducted across five Canadian provinces. A total of 3,357 community-dwelling adults with hypertension, already prescribed at least one once-daily antihypertensive medication, were randomly assigned to take their medication either in the morning or at bedtime. Participants were recruited through 436 primary care clinicians between 2017 and 2022, with follow-up continuing until December 2023. The trial assessed a composite primary outcome of all-cause death or emergency hospital visits for stroke, acute coronary syndrome, or heart failure. Secondary safety outcomes included falls, cognitive decline, and glaucoma diagnosis.
Over a median follow-up of 4.6 years, the rate of primary outcome events was 2.3 per 100 patient-years in the bedtime group and 2.4 per 100 patient-years in the morning group. The adjusted hazard ratio was 0.96 (95% CI: 0.77–1.19; p=0.70), indicating no statistically significant difference. None of the individual cardiovascular events or safety outcomes varied meaningfully between groups. Specifically, rates of falls, fractures, glaucoma, and cognitive changes were comparable across both timing strategies.
The study concluded that timing of antihypertensive medication does not influence major cardiovascular outcomes or safety. This suggests that clinicians can confidently base medication timing on patient preference and lifestyle considerations. A key limitation of the trial is its open-label design, which could introduce behavioural bias, although outcome assessment was blinded. These findings support a more flexible, patient-centred approach to hypertension management in clinical practice.
Reference
Garrison et al. Antihypertensive Medication Timing and Cardiovascular Events and Death: The BedMed Randomized Clinical Trial. JAMA. 2025;DOI: 10.1001/jama.2025.4390.
