Randomized crossover trial of the impact of morning or evening dosing of antihypertensive agents on 24-hour ambulatory blood pressure: the HARMONY trial

File Description SizeFormat 
HARMONY Trial Manuscript untracked 05062018.docxFile embargoed until 27 February 201941.66 kBMicrosoft Word    Request a copy
Title: Randomized crossover trial of the impact of morning or evening dosing of antihypertensive agents on 24-hour ambulatory blood pressure: the HARMONY trial
Author(s): Poulter, NR
Savopoulos, C
Anjum, A
Apostolopoulou, M
Chapman, N
Cross, M
Falaschetti, E
Fotiadis, S
James, RM
Kanellos, I
Szigeti, M
Thom, S
Sever, P
Thompson, D
Hatzitolios, AI
Item Type: Journal Article
Abstract: Some data suggest that nocturnal dosing of antihypertensive agents may reduce cardiovascular outcomes more than daytime dosing. This trial was designed to evaluate whether ambulatory blood pressure monitoring levels differ by timing of drug dosing. Patients aged 18 to 80 years with reasonably controlled hypertension (≤150/≤90 mm Hg) on stable therapy of ≥1 antihypertensive agent were recruited from 2 centers in London and Thessaloniki. Patients were randomized to receive usual therapy either in the morning (6 am–11 am) or evening (6 pm–11 pm) for 12 weeks when participants crossed over to the alternative timing for a further 12 weeks. Clinic blood pressures and a 24-hour recording were taken at baseline, 12, and 24 weeks and routine blood tests were taken at baseline. The study had 80% power to detect 3 mm Hg difference in mean 24-hour systolic blood pressure (α=0.05) by time of dosing. A 2-level hierarchical regression model adjusted for center, period, and sequence was used. Of 103 recruited patients (mean age, 62; 44% female), 95 patients (92%) completed all three 24-hour recordings. Mean 24-hour systolic and diastolic blood pressures did not differ between daytime and evening dosing. Similarly, morning and evening dosing had no differential impact on mean daytime (7 am–10 pm) and nighttime (10 pm–7 am) blood pressure levels nor on clinic levels. Stratification by age (≤65/≥65 years) or sex did not affect results. In summary, among hypertensive patients with reasonably well-controlled blood pressure, the timing of antihypertensive drug administration (morning or evening) did not affect mean 24-hour or clinic blood pressure levels.
Publication Date: 1-Oct-2018
Date of Acceptance: 30-Jul-2018
URI: http://hdl.handle.net/10044/1/63244
DOI: https://dx.doi.org/10.1161/HYPERTENSIONAHA.118.11101
ISSN: 0194-911X
Publisher: American Heart Association
Start Page: 870
End Page: 873
Journal / Book Title: Hypertension
Volume: 72
Issue: 4
Copyright Statement: © 2018 American Heart Association, Inc. This is a non-final version of an article published in final form in Hypertension, Vol 72, Iss 4, p870-873, at https://dx.doi.org/10.1161/HYPERTENSIONAHA.118.11101
Keywords: Science & Technology
Life Sciences & Biomedicine
Peripheral Vascular Disease
Cardiovascular System & Cardiology
ambulatory blood pressure
antihypertensive agents
dosing times
hypertension
randomized trial
CARDIOVASCULAR EVENTS
ETHNIC-DIFFERENCES
HYPERTENSION
GUIDELINES
MANAGEMENT
MORTALITY
SOCIETY
Science & Technology
Life Sciences & Biomedicine
Peripheral Vascular Disease
Cardiovascular System & Cardiology
ambulatory blood pressure
antihypertensive agents
dosing times
hypertension
randomized trial
CARDIOVASCULAR EVENTS
ETHNIC-DIFFERENCES
HYPERTENSION
GUIDELINES
MANAGEMENT
MORTALITY
SOCIETY
1103 Clinical Sciences
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Accepted
Embargo Date: 2019-02-27
Online Publication Date: 2018-08-27
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine
Epidemiology, Public Health and Primary Care



Items in Spiral are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commons