Administering one of three antihypertensive drugs at bedtime significantly reduced ambulatory blood pressure by 9.4/6.0 mm Hg (P<0.001) and increased the prevalence of dippers to 57%.
RCT (n=250)
Randomly assigned
Does administering one antihypertensive drug at bedtime improve blood pressure control and circadian pattern in patients with resistant hypertension?
In patients with resistant hypertension, shifting one antihypertensive medication to bedtime significantly improves ambulatory blood pressure control and restores the normal nocturnal dipping pattern.
Effect estimate: 9.4/6.0 mm Hg reduction
p-value: p=<0.001
Therapeutic strategies in resistant hypertension include adding another drug or changing drugs in search for a better synergic combination. Most patients, however, receive all of their drugs in a single morning dose. We have evaluated the impact on the circadian pattern of blood pressure on modifying the time of treatment without increasing the number of prescribed drugs. We studied 250 hypertensive patients who were receiving 3 antihypertensive drugs in a single morning dose. Patients were randomly assigned to 1 of 2 groups according to the modification in their treatment strategy: changing 1 of the drugs but keeping all 3 in the morning or the same approach but administering the new drug at bedtime. Blood pressure was measured for 48 hours before and after 12 weeks of treatment. There was no effect on ambulatory blood pressure when all of the drugs were taken on awakening. The baseline prevalence of nondipping (79%) was slightly increased after treatment (86%; P=0.131). The ambulatory blood pressure reduction was statistically significant (9.4/6.0 mm Hg for systolic/diastolic blood pressure; P<0.001) with 1 drug at bedtime. This reduction was larger in the nocturnal than in the diurnal mean of blood pressure. Thus, whereas only 16% of the patients in this group were dippers at baseline, 57% were dippers after therapy (P<0.001). Results indicate that, in resistant hypertension, time of treatment may be more important for blood pressure control and for the proper modeling of the circadian blood pressure pattern than just changing the drug combination.
Hermida et al. (Mon,) conducted a rct in Resistant hypertension (n=250). Administering one antihypertensive drug at bedtime vs. All 3 antihypertensive drugs taken in the morning was evaluated on Ambulatory blood pressure reduction (9.4/6.0 mm Hg reduction, p=<0.001). Administering one of three antihypertensive drugs at bedtime significantly reduced ambulatory blood pressure by 9.4/6.0 mm Hg (P<0.001) and increased the prevalence of dippers to 57%.