Evening Blood Pressure Medication Administration and Cardiovascular Events: Systematic Review and Meta-analysis
Bibliographic record
Abstract
Background Controversy persists whether evening administration of antihypertensive medications reduces cardiovascular events. We aimed to synthesize the randomized evidence comparing the risk of cardiovascular events with evening versus morning administration of antihypertensive medications. Methods We systematically searched MEDLINE, Embase, and CENTRAL from inception through May 13 2025. We included randomized controlled trials of adults with hypertension comparing evening administration of ≥1 antihypertensive medication to morning administration of all antihypertensive medications with ≥500 patient-years per group and median follow-up ≥12 months. Two reviewers extracted data, assessed risk of bias, and evaluated certainty of evidence. The primary outcome was the composite of major adverse cardiovascular events, as defined in each trial. Secondary outcomes included all-cause and cardiovascular deaths, myocardial infarctions, strokes, heart failure exacerbations, all-cause unplanned hospitalization/emergency department visits, fractures, glaucoma-related events, and worsening cognition. We obtained summary-level data from all trials, and additionally obtained patient-level outcome data for two trials (BedMed and BedMed-Frail). The primary meta-analysis pooled trial-level data using a random-effects frequentist approach. Results We included five randomized controlled trials with 46,606 patients (mean age 63.2 years; 25,515 men [55%]). Median follow-up was 5.2 years. Evening administration of antihypertensive medications, compared with morning administration, did not reduce the risk of major adverse cardiovascular events in all trials (hazard ratio, 0.71; 95% confidence interval, 0.43-1.16; I2=94%), or when restricted to three trials at low risk of bias (hazard ratio, 0.94; 95% confidence interval, 0.86-1.03; I2=0%). Conclusions Among adults with hypertension, evening compared with morning administration of antihypertensive medications did not reduce cardiovascular events.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.019 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.014 | 0.026 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".