Timing of Blood Pressure Dosing Doesn't Matter (Again): BedMed and BedMed-Frail скачать в хорошем качестве

Timing of Blood Pressure Dosing Doesn't Matter (Again): BedMed and BedMed-Frail

Tricia Ward asks Scott Garrison about BedMed and BedMed-Frail, his studies on morning vs bedtime dosing of blood pressure medications, and whether this is now-settled science. https://www.medscape.com/viewarticle/... -- TRANSCRIPT -- Tricia Ward: Hi. I'm Tricia Ward from theheart.org | Medscape Cardiology, and I'm here at the European Society of Cardiology (ESC) meeting in London. I'm joined today by Dr Scott Garrison. He is a professor in the Department of Family Medicine at the University of Alberta and director of the Pragmatic Trials Collaborative. Welcome, Dr Garrison. You presented two studies here today at ESC. One is the BedMed study, comparing day vs nighttime dosing of blood pressure therapy. Can you tell us the topline findings? BedMed and BedMed-Frail Scott R. Garrison, MD, PhD: We were looking to validate an earlier study that suggested a large benefit of taking blood pressure medication at bedtime, as far as reducing major adverse cardiovascular events (MACEs). That was the MAPEC study. They suggested a 60% reduction. The BedMed trial was in hypertensive primary care patients in five Canadian provinces. We randomized well over 3000 patients to bedtime or morning medications. We looked at MACEs — so all-cause death or hospitalizations for acute coronary syndrome, stroke, or heart failure, and a bunch of safety outcomes. Essentially, we found that it made absolutely no difference whatever time of day you took it in terms of MACEs and it didn't make any difference to the adverse effects. It was safe to take it at bedtime. But it did not convey any extra cardiovascular benefit. Ward: And then you did a second study, called BedMed-Frail. Do you want to tell us the reason you did that? Garrison: BedMed-Frail took place in a nursing home population. We believed that it was possible that frail, older adults might have very different risks and benefits, and that they would probably be underrepresented, as they normally are in the main trial. We thought that because bedtime blood pressure medications would be theoretically preferentially lowering night pressure, which is already the lowest pressure of the day, that if you were at risk for hypotensive or ischemic adverse events, that might make it worse. We looked at falls and fractures; worsening cognition in case they had vascular dementia; and whether they developed decubitus ulcers (pressure sores) because you need a certain amount of pressure to get past any obstruction — in this case, it's the weight of your body if you're lying in bed all the time. We also looked at problem behaviors. People who have dementia have what's called "sundowning," where agitation and confusion are worse as the evening is going on. We looked at that on the off chance that it had anything to do with blood pressures being lower. And the BedMed-Frail results mirror those of BedMed exactly. So there was no cardiovascular benefit, and in this population, that was largely driven by mortality; one third of these people died every year. Ward: The median age was about 88? Garrison: Yes, the median age was 88. There was no cardiovascular mortality advantage to bedtime dosing, but neither was there any signal of safety concerns. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/...