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Evening versus morning dosing regimen drug therapy for hypertension
Cochrane Reviews, 10/06/2011 Clinical Article
Zhao P et al. – The authors concluded that evening dosing with antihypertensive drugs had a slightly better blood pressure control than the morning dosing regimen in 24–hour BP, but its effect on death and adverse cardiovascular outcomes is not known.

Methods
The authors searched Cochrane CENTRAL on Ovid (4th Quarter 2009), Ovid MEDLINE (1950 to October 2009), EMBASE (1974 to October 2009), the Chinese Biomedical literature database (1978 to 2009) and the reference lists of relevant articles.
No language restrictions were applied.
Randomized controlled trials comparing the administration–time–related effects of evening with morning dosing monotherapy regimens in patients with primary hypertension were included.
Patients with known secondary hypertension, shift workers or white coat hypertension were excluded.
Data synthesis and analysis were done using RevMan 5.1.
Random effects meta–analysis and sensitivity analysis were conducted.
21 randomized controlled trials (RCTs) in 1,993 patients with primary hypertension met the inclusion criteria for this review – ACEIs (5 trials), CCBs (7 trials), ARBs (6 trials), diuretics (2 trials), alpha–blockers (1 trial), and beta–blockers (1 trial).
Results
Meta–analysis showed significant heterogeneity across trials.
No RCT reported on all cause mortality, cardiovascular mortality, cardiovascular morbidity and serious adverse events.
There was no statistically significant difference for overall adverse events (RR=0.78, 95%CI: 0.37 to 1.65) and withdrawals due to adverse events (RR=0.53, 95%CI: 0.26 to 1.07).
No significant differences were noted for morning SBP (–1.62 mm Hg, 95% CI: –4.19 to 0.95) and morning DBP (–1.21 mm Hg, 95% CI: –3.28 to 0.86); but 24–hour BP (SBP: –1.71 mm Hg, 95% CI: –2.78 to –0.65; DBP: –1.38 mm Hg, 95% CI: –2.13 to –0.62) showed a statistically significant difference.