December 31, 2009American Journal of Hypertension
Effects of Time of Antihypertensive Treatment on Ambulatory Blood Pressure and Clinical Characteristics of Subjects With Resistant Hypertension
Key result
Taking ≥1 antihypertensive medication at bedtime was associated with a lower prevalence of a nondipper blood pressure pattern (40% vs 83%, P<0.001) compared to morning dosing.
Why the study?
Does bedtime administration of antihypertensive medication improve ambulatory blood pressure control in subjects with resistant hypertension?
Population
1,794 subjects with resistant hypertension (including 1,306 with true resistant hypertension)
Comparison
Ingesting ≥1 antihypertensive drug at bedtime vs Ingesting all antihypertensive medications upon…
Design
Cross-sectional
Authors
Discussion
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Implication
Bedtime dosing was associated with better dipping in resistant hypertension; leaves open whether randomized trials confirm outcome benefit.
Key Points
- The study aims to evaluate how the timing of antihypertensive medication affects blood pressure and related clinical characteristics in individuals with resistant hypertension.
- 1,794 subjects with resistant hypertension were categorized based on medication timing: morning versus bedtime.
- Blood pressure was monitored for 48 hours, alongside physical activity via wrist actigraphy.
- Outcomes included controlled blood pressure rates and changes in clinical markers.
- Bedtime treatment resulted in higher control rates of blood pressure (P < 0.001).
- Subjects receiving bedtime treatment had a lower 24-hour average of systolic BP by 4.1 mm Hg and diastolic BP by 1.5 mm Hg (P < 0.015).
- Nondipper prevalence decreased from 83% to 40% (P < 0.001) with bedtime medication.
Study Design
Type
Observational (n=1,794)
Structured PICO
Does bedtime administration of antihypertensive medication improve ambulatory blood pressure control in subjects with resistant hypertension?
P
Population
1,794 subjects with resistant hypertension categorized by time of antihypertensive treatment and monitored for 48 hours.
E
Exposure
Ingesting ≥1 antihypertensive drug at bedtime
C
Comparator
Ingesting all antihypertensive medications upon awakening
O
Outcome
Ambulatory blood pressure (24-h mean SBP/DBP, asleep BP, awake/asleep BP ratio, and nondipping prevalence) measured for 48 consecutive hourssurrogate
Main Result
Absolute Event Rate: 40% vs 83%
p-value: p=<0.001
Bedtime administration of at least one antihypertensive medication in resistant hypertension is associated with better ambulatory BP control and a lower prevalence of the high-risk nondipper pattern.
Cite This Study
Hermida et al. (2009) conducted an observational in Resistant hypertension (n=1,794). Ingesting ≥1 antihypertensive drug at bedtime vs. Ingesting all antihypertensive medications upon awakening was evaluated on Prevalence of nondipping blood pressure pattern (p=<0.001). Taking ≥1 antihypertensive medication at bedtime was associated with a lower prevalence of a nondipper blood pressure pattern (40% vs 83%, P<0.001) compared to morning dosing.