BedMed
Trial question
What is the effect of bedtime administration of antihypertensive medications in patients with hypertension?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
56.0% female
44.0% male
N = 3357
3357 patients (1893 female, 1464 male).
Inclusion criteria: patients with hypertension taking at least one once-daily antihypertensive medication.
Key exclusion criteria: sleep-disrupting shift work; glaucoma or use of glaucoma medications; resident of continuing care facilities.
Interventions
N=1677 bedtime antihypertensive medication (taking all once-daily antihypertensive medications while readying for bed).
N=1680 morning antihypertensive medication (taking all once-daily antihypertensive medications on arising).
Primary outcome
Incidence of first occurrence of all-cause death or hospitalization/emergency department visit for stroke, acute coronary syndrome, or heart failure
2.3
2.4
2.4/100 py
1.8/100 py
1.2/100 py
0.6/100 py
0.0/100 py
Bedtime antihypertensive
medication
Morning antihypertensive
medication
No significant
difference ↔
No significant difference in the incidence of first occurrence of all-cause death or hospitalization/emergency department visit for stroke, acute coronary syndrome, or HF (2.3 events /100 py vs. 2.4 events /100 py; HR 0.96, 96% CI 0.77 to 1.19).
Secondary outcomes
No significant difference in the incidence of all-cause mortality (1.11 events /100 py vs. 1.28 events /100 py; HR 0.9, 95% CI 0.67 to 1.22).
No significant difference in the incidence of hospitalization/emergency department visit for stroke (0.37 events /100 py vs. 0.44 events /100 py; HR 0.86, 95% CI 0.52 to 1.44).
No significant difference in the incidence of hospitalization/emergency department visit for HF (0.41 events /100 py vs. 0.59 events /100 py; HR 0.72, 95% CI 0.45 to 1.15).
Safety outcomes
No significant differences in falls or fractures, new glaucoma diagnoses, 18-month cognitive decline.
Conclusion
In patients with hypertension taking at least one once-daily antihypertensive medication, bedtime antihypertensive medication was not superior to morning antihypertensive medication with respect to the incidence of first occurrence of all-cause death or hospitalization/emergency department visit for stroke, acute coronary syndrome, or HF.
Reference
Scott R Garrison, Jeffrey A Bakal, Michael R Kolber et al. Antihypertensive Medication Timing and Cardiovascular Events and Death: The BedMed Randomized Clinical Trial. JAMA. 2025 May 12:e254390. Online ahead of print.
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