Nighttime blood pressure strongly predicts cardiovascular events ( CVEs ) .
Further , a preliminary trial has shown decreased CVEs from evening vs morning dosing of antihypertensive therapy .
Unlike other EDTs , the Heart Outcomes Prevention Evaluation ( HOPE ) study administered its entire antihypertensive dose prior to sleep and gave the greatest risk reduction .
This study provides a third type of evidence suggesting a beneficial effect from evening dosing of antihypertensive therapy .
Comparative Effects of Ramipril on Ambulatory and Office Blood Pressures: A HOPE Substudy
In the HOPE-trial , the ACE inhibitor ramipril significantly reduced cardiovascular morbidity and mortality in patients at high risk for cardiovascular events . The benefit could only partly be attributed to the modest mean reduction of office blood pressure ( OBP ) during the study period ( 3/2 mm Hg ) . However , because according to the HOPE protocol ramipril was given once daily at bedtime and blood pressure was measured during the day , the 24-hour reduction of blood pressure may be underestimated based on OBP . Thirty-eight patients with peripheral arterial disease enrolled in the HOPE study underwent  24-hour ambulatory blood pressure ( ABP ) measurement  before r and omization and after 1 year . OBP was measured in the sitting position immediately before fitting the ABP measuring equipment to the patients . Ramipril did not significantly reduce OBP ( 8/2 mm Hg , P = NS ) or day ABP ( 6/2 mm Hg , P = NS ) after 1 year . Twenty-four – hour ABP was significantly reduced ( 10/4 mm Hg , P = 0.03 ) , mainly because of a more pronounced blood pressure lowering effect during nighttime ( 17/8 mm Hg , P < 0.001 ) . The night/day ratio was also significantly lowered in the ramipril  group . ABP shows greater falls , especially at night , than OBP during treatment with ramipril given once daily at bedtime . Although , OBP is the correct comparator when comparing with previous large intervention trials and epidemiological studies , the effects on cardiovascular morbidity and mortality seen with ramipril in the HOPE study may , to a larger extent than previously ascribed , relate to effects on blood pressure patterns over the 24-hour period
Nighttime blood pressure strongly predicts cardiovascular events ( CVEs ) .
Further , a preliminary trial has shown decreased CVEs from evening vs morning dosing of antihypertensive therapy .
Unlike other EDTs , the Heart Outcomes Prevention Evaluation ( HOPE ) study administered its entire antihypertensive dose prior to sleep and gave the greatest risk reduction .
This study provides a third type of evidence suggesting a beneficial effect from evening dosing of antihypertensive therapy .