Bedtime dosing of antihypertensive therapy provided no improvement in cardiovascular outcomes when compared with traditional morning dosing. The AHA Meeting (2025) report evaluated randomized controlled trials (RCTs) comparing cardiovascular risk based on dosing time.

The analysis included 7 RCTs with 63,459 adults (31,548 bedtime dosing; 31,785 morning dosing). The median age ranged from 55.6 to 80 years, and follow-up ranged from 1.1 to 6.3 years. MACE were assessed using a random-effects model and definitions specified by each trial.

The pooled analysis found no difference in MACE between the two groups (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.61–1.08). No significant differences were identified for all-cause death (HR 0.82; 95% CI 0.62–1.09), stroke (HR 0.86; 95% CI 0.58–1.28), MI (HR 0.87; 95% CI 0.72–1.06), or HF (HR 0.71; 95% CI 0.43–1.18). All confidence intervals crossed unity, indicating no clinical advantage for bedtime dosing.

These findings show that cardiovascular outcomes remain similar whether antihypertensive therapy is taken in the morning or at bedtime. Current evidence supports flexibility in routine dosing rather than a time-specific approach.