Key result
Bedtime antihypertensive dosing fails to reduce nocturnal systolic BP in hypertensive CKD.
Why the study?
Does bedtime dosing or adding a bedtime dose of antihypertensive medication reduce nocturnal systolic blood pressure in African Americans with hypertensive chronic kidney disease compared to morning dosing?
RCT (n=147)
open label
randomized, three period, cross-over trial
Yes
Does bedtime dosing or adding a bedtime dose of antihypertensive medication reduce nocturnal systolic blood pressure in African Americans with hypertensive chronic kidney disease compared to morning dosing?
Mean Difference: -1.7 (95% CI -4.05–0.65)
Absolute Event Rate: 123.9% vs 125.6%
p-value: p=0.15
Changing the timing of antihypertensive medications to bedtime did not significantly lower nocturnal blood pressure in African Americans with hypertensive CKD.
Does not support bedtime antihypertensive dosing for nocturnal BP control in African Americans with hypertensive CKD; challenges broader chronotherapy assumptions from other populations.
The objective of our study was to determine the effects of 2 antihypertensive drug dose schedules (PM dose and add-on dose) on nocturnal blood pressure (BP) in comparison with usual therapy (AM dose) in blacks with hypertensive chronic kidney disease and controlled office BP. In a 3-period, crossover trial, former participants of the African American Study of Kidney Disease were assigned to receive the following 3 regimens, each lasting 6 weeks, presented in random order: AM dose (once-daily antihypertensive medications taken in the morning), PM dose (once-daily antihypertensives taken at bedtime), and add-on dose (once-daily antihypertensives taken in the morning and an additional antihypertensive medication before bedtime [diltiazem 60-120 mg, hydralazine 25 mg, or additional ramipril 5 mg]). Ambulatory BP monitoring was performed at the end of each period. The primary outcome was nocturnal systolic BP. Mean age of the study population (n=147) was 65.4 years, 64% were men, and mean estimated glomerular filtration rate was 44.9 mL/min per 1.73 m(2). At the end of each period, mean (SE) nocturnal systolic BP was 125.6 (1.2) mm Hg in the AM dose, 123.9 (1.2) mm Hg in the PM dose, and 123.5 (1.2) mm Hg in the add-on dose. None of the pairwise differences in nocturnal, 24-hour, and daytime systolic BP was statistically significant. Among blacks with hypertensive chronic kidney disease, neither PM (bedtime) dosing of once-daily antihypertensive nor the addition of drugs taken at bedtime significantly reduced nocturnal BP compared with morning dosing of antihypertensive medications.
No takes yet. Share an insight, caveat, or question.
Rahman et al. (2012) conducted an RCT in hypertensive chronic kidney disease (n=147). PM dose (bedtime dosing) or Add-on dose (morning dosing plus bedtime dose) vs. AM dose (once-daily antihypertensive medications taken in the morning) was evaluated on nocturnal systolic BP (MD -1.7 mm Hg, 95% CI -4.05 to 0.65, p=0.15). Among African Americans with hypertensive chronic kidney disease, neither bedtime dosing nor the addition of a bedtime antihypertensive significantly reduced nocturnal systolic blood pressure compared with morning dosing.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: