Written by Mary Marschner
Spoon Feed
There is no benefit or harm from taking antihypertensive medications in the morning or at bedtime for frail older adults.
There’s no tricks to hypertension timing in geriatrics
I love a randomized control trial for our frail geriatric populations. Hypertension is common, and as patients age, they tend to have more events associated with hypertension (cardiac, stroke, heart failure) and also more falls leading to ER and hospital visits. Last week we covered BedMed, which was a negative trial. This study looked at whether the timing of blood pressure medications affected all-cause mortality, hospital or ED visits caused by stroke, acute coronary syndrome, or heart failure, as well as a host of secondary outcomes, one of which was falls.
In frail older adults (median age 88, N = 776), the BedMed‑Frail RCT randomized once‑daily antihypertensive dosing to bedtime (n 394) versus usual morning care (n 382). Over a median 415 days, the primary composite of death or hospitalization for MI, stroke, or heart failure occurred at similar rates: 29.4 vs 31.5 events per 100 patient‑years (adjusted HR 0.88; 95%CI 0.71–1.11; P = .28). No differences were seen in falls, fractures, ulcers, or cognitive decline, but unplanned hospital/ED visits were fewer with bedtime dosing (22.6 vs 30.0; aHR 0.74; 95%CI 0.57–0.96).
The study was limited by some nonadherence when it came to switching diuretics to nighttime, which seems reasonable. I also wonder about the reporting of falls and amount of help needed overnight. These patients were all in care units and theoretically had access to help getting out of bed at night, so I wonder if the results can be extrapolated to frail older adults living at home.
How does this change my practice?
This study makes things simple – does your patient prefer to take most medications in the morning or at night? I’ll just let them choose.
Source
Bedtime vs Morning Antihypertensive Medications in Frail Older Adults: The BedMed-Frail Randomized Clinical Trial. JAMA Netw Open. 2025 May 1;8(5):e2513812. doi: 10.1001/jamanetworkopen.2025.13812. PMID: 40354050
