Bedtime Dosing of Blood Pressure Medications Shows Measurable Benefits
New trial suggests evening administration of olmesartan-amlodipine may improve nocturnal blood pressure control without added risks
A multicenter randomized trial in China found that taking olmesartan-amlodipine at bedtime reduced nighttime systolic blood pressure by an additional 3 mm Hg compared with morning dosing, with improved circadian rhythm and no increase in nocturnal hypotension.
Study Details
Researchers from Sichuan University examined whether the timing of antihypertensive medication impacts nocturnal blood pressure control in adults with hypertension. The trial, conducted between June 2022 and April 2024 across 15 hospitals in China, included 720 participants without cardiovascular disease.
Participants were randomly assigned to take a single-pill combination of olmesartan (20 mg) and amlodipine (5 mg) either in the morning (6–10 AM) or at bedtime (6–10 PM) for 12 weeks.
Methodology
Blood pressure was measured using both office and ambulatory monitoring at baseline, 4 weeks, 8 weeks, and 12 weeks. Dose adjustments were permitted based on readings at weeks 4 and 8. The main endpoint was the change in nighttime systolic blood pressure after 12 weeks.
Key Findings
Greater nocturnal BP reduction: Bedtime dosing reduced nighttime systolic BP by an additional 3.0 mm Hg compared with morning dosing.
Higher control rates: 79% of the bedtime group achieved nocturnal BP control vs 69.8% in the morning group.
Less medication titration: Only 52.7% in the bedtime group required increased dosage at week 4, compared with 61.5% in the morning group.
Improved circadian rhythm: Better overall day-night BP pattern without compromising daytime or 24-hour BP control.
No added safety risk: No difference in nocturnal hypotension incidence between groups.
Implications for Practice
For patients without cardiovascular disease, bedtime dosing of olmesartan-amlodipine could offer a simple, non-invasive strategy to improve nighttime blood pressure control and overall circadian rhythm. This may be particularly relevant for those with elevated nocturnal BP - a known risk factor for cardiovascular events. However, applicability to other populations, including those with cardiovascular disease or different ethnic backgrounds, remains to be studied.
Healthcare providers should weigh the potential benefits of bedtime dosing against patient-specific factors, medication adherence patterns, and availability of ambulatory blood pressure monitoring to guide therapy.