Antihypertensive Medications for Three-Times-Weekly Dosing
No standard antihypertensive medication is designed or recommended for three-times-weekly administration. All major hypertension guidelines explicitly recommend once-daily dosing to improve medication adherence and achieve consistent 24-hour blood pressure control 1.
Why Once-Daily Dosing Is the Standard
The ACC/AHA guidelines state that dosing antihypertensive medications once daily rather than multiple times daily is beneficial to improve adherence (Class I recommendation, Level B evidence) 1.
Once-daily long-acting medications provide homogeneous 24-hour blood pressure reduction, whereas intermittent dosing (such as three times weekly) causes blood pressure fluctuations that are associated with negative cardiovascular outcomes 2.
Both the ACCORD and SPRINT trials—landmark studies demonstrating cardiovascular benefit from blood pressure control—utilized once-daily long-acting medications when possible 1.
Pharmacologic Rationale Against Intermittent Dosing
Antihypertensive drugs with flat dose-response curves (particularly ACE inhibitors and ARBs) require consistent daily dosing to maintain therapeutic blood levels throughout the 24-hour period 2.
Lower or intermittent doses of these medications have the same peak potency but a shorter duration of action, leading to blood pressure variability that increases cardiovascular risk 2.
The goal of antihypertensive therapy is to achieve smooth, sustained blood pressure reduction over the entire dosing interval—ideally 24 hours—which cannot be accomplished with three-times-weekly administration 2.
Guideline-Recommended Approach for Poor Adherence
If the question stems from concerns about medication adherence or cost:
Use single-pill combination therapy rather than multiple separate pills, which improves adherence (Class IIa recommendation, Level B evidence) 1.
Select medications with proven once-daily efficacy: thiazide-like diuretics (chlorthalidone 12.5-25 mg), long-acting ACE inhibitors or ARBs, and long-acting calcium channel blockers (amlodipine 5-10 mg) 3, 4.
Address cost barriers directly through generic substitutions, patient assistance programs, or simplified regimens rather than compromising dosing frequency 1.