Evidence map›Paper›PMID 31641769›Full record

ArticleEuropean heart journal2020

Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial.

Ramón C Hermida, Juan J Crespo, Manuel Domínguez-Sardiña, Alfonso Otero, Ana Moyá, María T Ríos, Elvira Sineiro, María C Castiñeira, Pedro A Callejas, Lorenzo Pousa and 7 more

Expression of concern 2 registry-linked trialsOpen access · bronzeAbstract readControlled Clinical TrialMulticenter Study
PubMed Publisher
In one paragraph

Article in European heart journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It carries an expression of concern. It is linked to 2 registered trials, which are not on this map. Cited by 170 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
170citing papers in PubMed, 11 pooled it
39.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00741585 phase4completednot on this map

Prognostic Value of the Circadian Pattern of Ambulatory Blood Pressure for Multiple Risk Assessment

TypeinterventionalSponsorUniversity of VigoRan2008 to 2018Enrolled21,983ConditionsEssential Hypertension, Cardiovascular Disease, Stroke, Chronic Kidney DiseaseArmsAny antihypertensive medication alone or in combination, Ambulatory blood pressure monitoring
NCT05322967 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Chronotherapy in Hypertension - a Study of Blood Pressure Levels Following Intake of Antihypertensive Medication in the Morning or at Bedtime

TypeinterventionalSponsorVastra Gotaland RegionRan2022 to 2025Enrolled120ConditionsHypertension, Drug Therapy, Primary Health CareArmsTime of ordinary antihypertensive medication intake
3 · Its place in the literature

Who cites it

170 citing papers in PubMed, 11 syntheses or guidelines pooled it, 438 citations in OpenAlex.

  1. Pooled it
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  3. Bedtime Versus Morning Dosing of Anti-hypertensives: A GRADE-Assessed Meta-Analysis of Randomized Controlled Trials with Trial Sequential Evidence.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026
    Pooled it
  4. Timing of antihypertensive medication (bedtimeFrontiers in pharmacology · 2026
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  6. Chronotherapy for Hypertension: A Meta-Analysis and Systematic Review of RCTs.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025
    Pooled it
  7. Evening versus morning dosing regimen drug therapy for hypertension.The Cochrane database of systematic reviews · 2024
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110 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 2 institutions in 1 country.

Ramón C HermidaBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Juan J CrespoBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Manuel Domínguez-SardiñaEstructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo 36214, Spain.
Alfonso OteroServicio de Nefrología, Complejo Hospitalario Universitario, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS), Ourense 32005, Spain.
Ana MoyáEstructura de Xerencia Integrada Pontevedra e O Salnés, Servicio Galego de Saúde (SERGAS), Pontevedra 36156, Spain.
María T RíosBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Elvira SineiroBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
María C CastiñeiraBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Pedro A CallejasBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Lorenzo PousaBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
José L SalgadoBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Carmen DuránEstructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo 36214, Spain.
Juan J SánchezBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
José R FernándezBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Artemio MojónBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Diana E AyalaBioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo 36310, Spain.
Hygia Project Investigators
Servicio Gallego de Salud · ESUniversidade de Vigo · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsThe Hygia Chronotherapy Trial, conducted within the clinical primary care setting, was designed to test whether bedtime in comparison to usual upon awakening hypertension therapy exerts better cardiovascular disease (CVD) risk reduction. METHODS AND

resultsIn this multicentre, controlled, prospective endpoint trial, 19 084 hypertensive patients (10 614 men/8470 women, 60.5 ± 13.7 years of age) were assigned (1:1) to ingest the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ambulatory blood pressure (ABP) monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome (CVD death, myocardial infarction, coronary revascularization, heart failure, or stroke). Patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower hazard ratio-adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic blood pressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event-of the primary CVD outcome [0.55 (95% CI 0.50-0.61), P < 0.001] and each of its single components (P < 0.001 in all cases), i.e. CVD death [0.44 (0.34-0.56)], myocardial infarction [0.66 (0.52-0.84)], coronary revascularization [0.60 (0.47-0.75)], heart failure [0.58 (0.49-0.70)], and stroke [0.51 (0.41-0.63)].

conclusionRoutine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e. BP dipping) and, most importantly, markedly diminished occurrence of major CVD events.

trial registrationClinicalTrials.gov, number NCT00741585.

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 2HypertensionAgedAntihypertensive AgentsBlood PressureBlood Pressure Monitoring, AmbulatoryChronotherapyCircadian RhythmFemaleHeart Disease Risk FactorsHumansMaleMiddle AgedProspective StudiesRisk FactorsAntihypertensive AgentsAmbulatory blood pressure monitoringAngiotensin-converting enzyme inhibitorsAngiotensin-II receptor blockersAsleep blood pressureBedtime hypertension chronotherapyCardiovascular riskCoronary revascularizationHeart failureMyocardial infarctionStroke

Identifiers

PMID31641769
OpenAlexW2982141734

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.