Improvement in nocturnal blood pressure with bedtime antihypertensive administration in older adults aged 65 and above: a systematic review and meta-analysis.

Abstract

Purpose: This study evaluated the effectiveness of morning versus bedtime antihypertensive medication administration in reducing ambulatory blood pressure (BP) in older adults aged ≥ 65, and to assess whether administration timing influences conversion from a non-dipper to a dipper BP profile.

Methods: Eight randomized controlled trials were identified through systematically screening of the PubMed and Web of Science databases. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analyses were conducted with Review Manager version 5.4 to compare the efficacy of morning versus bedtime administration on ambulatory BP indices.

Results: Bedtime administration resulted in significantly greater reductions in nocturnal systolic BP (mean difference [MD] - 4.52 mmHg, [lower and upper 95% confidence intervals [CI] - 7.15; - 1.90]; p = 0.0007) and diastolic BP (MD - 2.00 mmHg, [95% CI - 2.90; - 1.10]; p < 0.0001). No significant differences were observed in diurnal systolic BP (MD 1.28 mmHg, [95% CI - 0.17; 2.72]; p = 0.08), diastolic BP (MD 0.34 mmHg, [95% CI - 0.49; 1.16]; p = 0.42), 24/48-h systolic BP (MD - 0.02 mmHg, [95% CI - 1.37; 1.33]; p = 0.98), or 24/48-h diastolic BP (MD - 0.50 mmHg, [95% CI - 1.45; 0.45]; p = 0.30). Sensitivity analysis excluding the controversial data from Hermida confirmed significantly greater reductions in nocturnal systolic and diastolic BP with bedtime administration. Two of three studies reported that bedtime administration was associated with a lower proportion of non-dippers than morning treatment.

Conclusion: Bedtime antihypertensive administration improves control of nocturnal BP in older adults aged ≥ 65 and may facilitate restoration to a dipper BP profile. No significant differences were observed in diurnal or 24/48-h mean BP reductions compared with morning administration.