Chronotherapy in hypertension: a systematic review and meta-analysis of antihypertensive dosing timing on cardiovascular outcomes.

We conducted an updated systematic review and meta-analysis comparing the effect of morning versus nighttime (evening or bedtime) administration of antihypertensive drugs on cardiovascular outcomes. We searched PubMed, Embase, and the Web of Science for studies that enrolled patients with hypertension who received medication administered in the morning or at night. A total of 42,075 patients from the five studies were included. No significant differences were observed between morning and nighttime dosing for all-cause mortality (RR 0.99, 95% CI 0.91-1.08), myocardial infarction (RR 1.14, 95% CI 0.98-1.33), major adverse cardiovascular events (RR 1.04, 95% CI 0.92-1.19), or stroke (RR 0.95, 95% CI 0.75-1.20). These findings suggest that the timing of antihypertensive administration does not significantly influence major cardiovascular outcomes. Our results align with contemporary high-quality randomized trials (TIME, BedMed) and contrast with earlier meta-analyses. Clinical trial number Not applicable as this is a systematic review per PRISMA Guidelines.