What question did this study set out to answer?

To assess whether the administration time-dependent antihypertensive efficacy and nocturnal blood pressure dipping improvements of bedtime dosing extend to the long-acting angiotensin receptor blocker telmisartan.

July 17, 2007HypertensionOpen Access

Comparison of the Efficacy of Morning Versus Evening Administration of Telmisartan in Essential Hypertension

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Essential hypertension (n=215). Intervention: Telmisartan (bedtime administration) vs. Telmisartan (morning administration). Primary outcome: Blood pressure reduction and sleep time-relative blood pressure decline.

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Key result

Bedtime administration of telmisartan (80 mg/d) was more efficient than morning dosing in reducing nocturnal blood pressure mean and reduced the prevalence of nondipping from baseline by 76%.

Why the study?

Does bedtime administration of telmisartan improve nocturnal blood pressure regulation compared to morning administration in patients with essential hypertension?

Key Points

To assess whether the administration time-dependent antihypertensive efficacy and nocturnal blood pressure dipping improvements of bedtime dosing extend to the long-acting angiotensin receptor blocker telmisartan.
Randomized trial of 215 patients with essential hypertension (114 men, 101 women; mean age 46.4 ± 12.0 years) assigned to telmisartan monotherapy (80 mg/day) either upon awakening or at bedtime.
Blood pressure was recorded using 48-hour ambulatory blood pressure monitoring before and after 12 weeks of treatment.
Both morning and bedtime regimens achieved significant and comparable overall 24-hour blood pressure reductions.
Bedtime administration was more efficient than morning dosing at lowering the nocturnal blood pressure mean and significantly enhanced the sleep time-relative blood pressure decline toward a dipper pattern.
Bedtime dosing reduced the prevalence of non-dipping blood pressure by 76% from baseline, whereas morning dosing slightly attenuated the nocturnal decline.

Study Design

Type

RCT (n=215)

Randomization

randomly assigned

Structured PICO

Does bedtime administration of telmisartan improve nocturnal blood pressure regulation compared to morning administration in patients with essential hypertension?

Population

215 patients with hypertension (mean age 46.4 years, 47% female) randomly assigned to morning or bedtime telmisartan for 12 weeks.

Intervention

Telmisartan 80 mg/d as monotherapy administered at bedtime for 12 weeks

Comparator

Telmisartan 80 mg/d as monotherapy administered on awakening for 12 weeks

Outcome

Blood pressure reduction (including 24-hour efficacy, nocturnal blood pressure mean, and sleep time-relative blood pressure decline) measured for 48 hours after 12 weeks of treatmentsurrogate

Bedtime administration of telmisartan improves nocturnal blood pressure regulation and restores a dipper pattern better than morning administration in patients with essential hypertension.

Discussion

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Implication

Favors bedtime telmisartan dosing for nocturnal BP control; extends chronotherapy benefits to long-acting ARBs.

Cite This Study

Hermida et al. (2007) conducted an RCT in Essential hypertension (n=215). Telmisartan (bedtime administration) vs. Telmisartan (morning administration) was evaluated on Blood pressure reduction and sleep time-relative blood pressure decline. Bedtime administration of telmisartan (80 mg/d) was more efficient than morning dosing in reducing nocturnal blood pressure mean and reduced the prevalence of nondipping from baseline by 76%.

synapsesocial.com/papers/6a71d40726770c2b8de13deb https://doi.org/10.1161/hypertensionaha.107.094235

Topics

Hypertension management

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