Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Network Open, 8(7), e2519354. https://doi.org/10.1001/jamanetworkopen.2025.19354 Dr. Runyu Ye et al.
Points
- Patients taking antihypertensive medication at bedtime experienced a significantly greater reduction in their nighttime systolic blood pressure compared to those who took their medication in the morning.
- Bedtime dosing also resulted in better overall nocturnal blood pressure control rates, improved circadian rhythm, and required fewer dose escalations throughout the twelve-week study period.
- This multicenter randomized clinical trial involved 720 patients with hypertension in China who were assigned to take an olmesartan and amlodipine combination pill daily.
- Importantly, the improved efficacy of bedtime administration did not come at the cost of increased adverse effects or a higher incidence of nocturnal hypotension in either group.
- These findings support the clinical application of antihypertensive chronotherapy, offering a simple yet effective strategy to enhance the management of difficult-to-control nocturnal hypertension for many patients.
Summary
A multicenter randomized clinical trial in China involving 720 patients with hypertension evaluated the effects of antihypertensive chronotherapy on nocturnal blood pressure. The OMAN trial assigned participants, with a mean age of 55.5 years, to receive a single-pill combination of olmesartan (20 mg) and amlodipine (5 mg) in either the morning (6:00-10:00 am) or at bedtime (6:00-10:00 pm) for 12 weeks. The study’s primary objective was to compare the change in nighttime systolic blood pressure from baseline between the two groups.
After 12 weeks, the bedtime dosing group demonstrated a significantly greater reduction in nighttime systolic blood pressure, with a between-group difference of -3.0 mmHg (95% CI, -5.1 to -1.0 mmHg; P = .004). This group also showed a greater decrease in nighttime diastolic blood pressure (-1.4 mm Hg; 95% CI, -2.8 to -0.1 mm Hg; P = .04). Consequently, nocturnal systolic blood pressure control was achieved in a higher proportion of patients in the bedtime group compared to the morning group (79.0% vs. 69.8%; P = .01), alongside an improved circadian rhythm.
The enhanced nocturnal efficacy of bedtime dosing did not compromise daytime or 24-hour blood pressure control and was not associated with an increased incidence of nocturnal hypotension or other adverse effects. These findings provide strong evidence supporting the potential advantages of bedtime administration in improving the management of nocturnal hypertension, a key predictor of cardiovascular events, and offer a practical adjustment to standard treatment protocols.
Link to the article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836172
References Ye, R., Yang, X., Zhang, X., Zuo, X., Li, Y., Jia, S., Xu, M., Liu, L., Wang, S., Liu, K., Meng, Q., Liao, H., Zhang, Z., Shi, R., Li, X., Liu, X., Sun, L., Zhang, X., Ran, Q., … Chen, X. (2025). Morning vs bedtime dosing and nocturnal blood pressure reduction in patients with hypertension: The oman randomized clinical trial. JAMA Network Open, 8(7), e2519354. https://doi.org/10.1001/jamanetworkopen.2025.19354
