REVIEWS AND META-ANALYSESCircadian variations in blood pressure and their implications for the administration of antihypertensive drugs: is dosing in the evening better than in the morning?Burnier, Michela; Kreutz, Reinholdb; Narkiewicz, Krzysztofc; Kjeldsen, Sverred; Oparil, Suzannee; Mancia, GiuseppefAuthor Information aService of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland bCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany cDepartment of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland dDepartment of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway eDepartment of Medicine, Vascular Biology and Hypertension Programme, University of Alabama at Birmingham, Birmingham, Alabama, USA fUniversity of Milano-Bicocca, Milan, Italy Correspondence to Michel Burnier, MD, Emeritus Professor, Service of Nephrology and Hypertension, Faculte de biologie et medicine, Universite de Lausanne, Rue du Bugnon 17, Lausanne 1011, Switzerland. E-mail: email@example.com Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; CKD, chronic kidney disease; CONVINCE, Controlled Onset Verapamil Investigation of Cardiovascular End Points trial; FACET, Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial; HMOD, hypertension-mediated organ damage; HOPE, Heart Outcomes Prevention Evaluation Study; MAPEC, Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares; PROBE, prospective randomised, open-label, blinded endpoint; RCT, randomized controlled trial; Syst-CHINA, Systolic Hypertension in China; Syst-Eur, Systolic Hypertension in Europe; TIME; Treatment In Morning versus Evening study Received 7 May, 2020 Accepted 7 May, 2020 Journal of Hypertension: August 2020 - Volume 38 - Issue 8 - p 1396-1406 doi: 10.1097/HJH.0000000000002532 Buy Metrics Abstract Blood pressure (BP) follows a circadian rhythm with a physiological decrease during the night. Studies have demonstrated that nocturnal BP as well as its dipping pattern during night-time have a significant prognostic importance for mortality and the occurrence of cardiovascular events. Therefore, hypertension management guidelines recommend to ascertain that patients treated for hypertension have well controlled BP values around the clock. To improve hypertension control during the night and eventually further reduce cardiovascular events, it has been proposed by some to prescribe at least one antihypertensive medication at bedtime. In this review, we have examined the data which could support the benefits of prescribing BP-lowering drugs at bedtime. Our conclusion is that there is no convincing evidence that the administration of BP-lowering drugs in the evening provides any significant advantage in terms of quality of BP control, prevention of target organ damage or reduction of cardiovascular events. Before changing practice for unproven benefits, it would be wise to wait for the results of the ongoing trials that are addressing this issue. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.