Treatment in Morning versus Evening - TIME

Oct 31, 2022
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
British Heart Foundation and BIHS
Date Presented:
08/26/2022
Date Updated:
10/31/2022
Original Posted Date:
08/27/2022
References

Contribution To Literature:

Highlighted text has been updated as of October 17, 2022.

The TIME trial showed that antihypertensive therapy can be taken either in the morning or in the evening according to patient preference.

Description:

The goal of the trial was to evaluate if taking blood pressure medications in the evening compared with the morning would be preferential among hypertensive individuals.

Study Design

  • Randomization
  • Parallel

Hypertensive patients were randomized to evening dosing (8:00 pm to midnight) of blood pressure medications versus morning dosing (6:00 am to 10:00 am) of blood pressure medications.

  • Total number of enrollees: 21,104
  • Duration of follow-up: 5 years
  • Mean patient age: 65 years
  • Percentage female: 43%
  • Percentage with diabetes: 14%

Inclusion criteria:

  • Hypertensive adults

Other salient features/characteristics:

  • Systolic blood pressure measured in the morning was higher in the morning dosing group versus the evening dosing group
  • Systolic blood pressure measured in the evening was higher in the evening dosing group versus the evening morning dosing group

Principal Findings:

The primary outcome, vascular death, myocardial infarction, or stroke occurred in 3.4% of the evening dosing group vs. 3.7% of the morning dosing group (p = 0.53).

Secondary outcomes:

  • Stroke: 1.2% for evening dosing vs. 1.3% for morning dosing: (p = 0.54)
  • Falls: 21.1% for evening dosing vs. 22.2% for morning dosing (p = 0.048)

Interpretation:

Among patients with hypertension, the timing of blood pressure medications does not affect the incidence of adverse cardiovascular events. Blood pressure tended to be higher in the evening among patients randomized to evening dosing, while blood pressure tended to be higher in the morning among patients randomized to morning dosing. Falls were slightly less frequent in the evening dosing group. There were no safety concerns from evening dosing of antihypertensive therapy. Patients can take antihypertensive medications in the morning or in the evening according to their preference.

References:

Mackenzie IS, Rogers A, Poulter NR, et al., on behalf of the TIME Study Group. Cardiovascular Outcomes in Adults With Hypertension With Evening Versus Morning Dosing of Usual Antihypertensives in the UK (TIME Study): A Prospective, Randomized, Open-Label, Blinded-Endpoint Clinical Trial. Lancet 2022;400:1417-25.

Editorial Comment: Salah HM, Mehta JL. Best time for administration of antihypertensive medications: morning or evening? Lancet 2022;400:1383-5.

Presented by Dr. Thomas MacDonald at the European Society of Cardiology Congress (ESC 2022), Barcelona, Spain, August 26, 2022.

Clinical Topics: Acute Coronary Syndromes, Prevention, Hypertension

Keywords: ESC Congress, ESC22, Accidental Falls, Acute Coronary Syndrome, Antihypertensive Agents, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Hypertension, Myocardial Infarction, Patient Preference, Primary Prevention, Stroke, Vascular Diseases


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