De recente resultaten van de Hygia Chronotherapy Trial lijken bijna te mooi om waar te zijn.1,2 Door één antihypertensivum ’s avonds in te nemen in plaats van in de ochtend kan het risico op hart- en vaatziekten met maar liefst 45% worden verlaagd. Moeten we deze relatief simpele interventie direct implementeren of is enige terughoudendheid geboden?
Various studies suggest that evening dosing of antihypertensive drugs may be more effective. In line, a randomized open-label trial in 19,084 hypertensive patients recently demonstrated that evening dosing of at least one antihypertensive drug resulted in a 3.3 mmHg lower systolic night-time blood pressure and 1.3 mmHg lower systolic 48-hour blood pressure when compared to morning dosing. Cardiovascular outcomes were reduced by 45% in the evening dosing group, which is remarkable as previous meta-analyses have shown that a systolic blood pressure reduction of 3 mmHg is associated with a 7% reduction in cardiovascular outcome. Although this discrepancy may be partly explained by specific beneficial effects related to evening dosing, it is likely that the open-label trial design may have affected the study outcome in different ways. Also, the safety of evening dosing in elderly hypertensive patients and the consequences for therapy compliance in the clinical setting remain to be established.
Conflict of interest and financial support: none declared.