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Reviews in Cardiovascular Medicine  2019, Vol. 20 Issue (2): 91-98     DOI: 10.31083/j.rcm.2019.02.31814
Systematic Review Previous articles | Next articles
Anti-hypertensive efficacy of amlodipine dosing during morning versus evening: A meta-analysis
Yifan Luo1, 2, Lixiang Ren3, Mingyan Jiang1, Yang Chu1, 2, *()
1 Department of Pharmacy, the First Hospital of China Medical University, Shenyang 110001, P.R. China
2 School of Pharmacy, China Medical University, Shenyang 110001, P.R. China
3 Safety Evaluation Center, Shenyang Research Institute of Chemical Industry, Shenyang 110021, P.R. China
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A meta-analysis was performed to compare the antihypertensive efficacy of morning and evening dosing. Database of Pubmed, Embase, Cochrane, Web of Science CNKI, VIP, and Wanfang were searched up to December 2018. A total of 19 randomized control trials and 1215 participants were included in this meta-analysis. Administration time of amlodipine did not affect the office blood pressure (RR = -0.03, 95% CI -0.93-0.88, P = 0.96), daytime blood pressure (RR = -0.30, 95% CI -1.05-0.46, P = 0.44), 24 h mean blood pressure (RR = 1.15, 95% CI -0.39-2.70, P = 0.14), or heart rate (RR = 0.11, 95% CI -1.22-1.45, P = 0.87). Administration of amlodipine in the evening could significantly reduce the nighttime blood pressure (RR = 2.04, 95% CI 1.27-2.81, P < 0.00001), increased non-dipper alteration (RR = 0.51, 95% CI 0.41-0.63, P < 0.00001), and contained better anti-hypertension efficacy (RR = 0.64, 95% CI 0.550.74, P < 0.00001). For patients with hypertension, especially for non-dipper hypertension, taking amlodipine in the evening will be more beneficial. Better quality trials conducted in different regions and with larger sample size are necessary to verify the conclusion of this study.

Key words:  Amlodipine      blood pressure      chronopharmacodynamics      hypertension      meta-analysis     
Submitted:  15 May 2019      Accepted:  11 June 2019      Published:  30 June 2019     
  • China Medical Hand in Hand Engineering Committee
  • YXJL-2018-0616-0060/Beijing Medical Award Foundation
*Corresponding Author(s):  Yang Chu     E-mail:

Cite this article: 

Yifan Luo, Lixiang Ren, Mingyan Jiang, Yang Chu. Anti-hypertensive efficacy of amlodipine dosing during morning versus evening: A meta-analysis. Reviews in Cardiovascular Medicine, 2019, 20(2): 91-98.

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Figure 1.  Flow diagram of the study.

Table 1  Characteristics of the included studies.
Study Region Study design Participants Sample size Outcomes
Chen and Huang (2012) China RCT Class I essential hypertension 61 3-8
Chen (2013) China RCT Class I and II essential hypertension 80 7-8
Feng (2013) China RCT non-dipper essential hypertension (elder) 68 1-2, 7-8, 10-11
Hou (2016) China RCT non-dipper hypertension (elder) 100 7-8, 11
Khodadoustan et al. (2017) India RCT primary hypertension 6 7-9,
Li et al. (2011) China RCT non-dipper hypertension 38 3-6,
Lin and Wu (2016) China RCT non-dipper hypertension (elder) 94 7-8, 11
Mengden et al. (1993) Switzerland RCT mild-to-moderate essential hypertension 20 1-6, 9
Nold et al. (1998) Germany RCT mild-to-moderate essential hypertension 12 3-9
Qiu et al. (2000) China RCT mild-to-moderate hypertension 32 1-9
Qiu et al. (2003) China RCT mild-to-moderate essential hypertension 62 1-9
Ren (2013) China RCT non-dipper Class II essential hypertension 48 3-8, 10
Sun et al. (2007) China RCT non-dipper essential hypertension (elder) 54 1, 5, 10-11
Tang et al. (2014) China RCT essential systolic hypertension 160 1, 3, 5, 7, 11
Wang (2013) China RCT non-dipper essential hypertension (elder) 90 3-8, 10
Xiao et al. (2009) China RCT essential systolic hypertension 86 1, 7, 11
Yan (2014) China RCT non-dipper essential hypertension (elder) 62 1-2, 5-8
Zhang et al. (2012) China RCT non-dipper essential hypertension (elder) 58 1-2, 5-8, 10
Zhou and Li (2012) China RCT non-dipper essential hypertension (elder) 84 3-8, 10
Figure 2.  Comparison changes of office BP after taking amlodipine in the morning or in the evening.

Figure 3.  Comparison changes of daytime-BP after taking amlodipine in the morning or in the evening.

Figure 4.  Comparison changes of nighttime BP after taking amlodipine in the morning or in the evening.

Figure 5.  Comparison changes of 24 h BP after taking amlodipine in the morning or in the evening.

Figure 6.  Comparison changes of heart rate after taking amlodipine in the morning or in the evening.

Figure 7.  Comparison non-dipper alteration after taking amlodipine in the morning or in the evening.

Figure 8.  Comparison anti-hypertensive efficient after taking amlodipine in the morning or in the evening.

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