Key result
Taking antihypertensive drugs in the evening significantly reduced total events and major cardiovascular events (P<0.001) compared to morning dosing in CKD patients with hypertension.
Why the study?
Does evening dosing of antihypertensive therapy reduce cardiovascular events and lower nighttime blood pressure in CKD patients with hypertension?
Systematic Review (n=1,277)
Does evening dosing of antihypertensive therapy reduce cardiovascular events and lower nighttime blood pressure in CKD patients with hypertension?
p-value: p=<0.001
Evening administration of antihypertensive medications in patients with CKD and hypertension may reduce major cardiovascular events and lower nighttime blood pressure compared to morning dosing.
Supports evening antihypertensive dosing in hypertensive CKD to cut CV events; extends chronotherapy evidence to renal disease.
BACKGROUND/AIMS: There is a strong correlation between non-dipping status and cardiovascular events in chronic kidney disease (CKD) patients. Our study is designed to identify the effect of evening administration of antihypertensive drugs to hypertensive CKD patients. METHODS: A comprehensive search of Medline, Embase, the Chinese Biomedical Literature Database, Wanfang Data, Chinese National Knowledge Infrastructure, and the Cochrane Central Register of Controlled Trials was performed in July 2014. Concurrent controlled or crossover trials (including randomized and non-randomized experimental trials) designed to evaluate the effects of evening- versus morning-dosing hypertensive drug regimens on clinical outcomes in CKD patients with hypertension were included. All statistical analyses were performed using the RevMan software, which is available free from the Cochrane Collaboration. RESULTS: Seven trials involving 1277 patients were identified, and the randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were classified into two groups. Taking at least one blood pressure-lowering medication at bedtime was not shown to reduce total death (P=0.056) or cardiovascular death (P=0.059) but was shown to reduce total events (P<0.001) and major cardiovascular events (P<0.001) in both RCTs and non-RCTs. Compared with a morning dosing regimen, taking antihypertensive drug in the evening significantly lowered nighttime systolic blood pressure (SBP) (P<0.0001) and diastolic blood pressure (P<0.05) in patients in the RCTs but did not affect blood pressure in patients in the non-RCTs (P<0.05). There is limited evidence from one non-RCT that taking an antihypertensive drug (benazepril 10 mg) in the evening did not increase adverse events (P=0.72) or withdrawals due to adverse events (P=0.64). CONCLUSIONS: A regimen of antihypertensive drugs in the evening should be considered for CKD patients with hypertension to lower nighttime blood pressure and help prevent total events and cardiovascular mortality. More studies are needed to verify the results of this study.
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Liu et al. (2014) conducted a systematic review in Chronic Kidney Disease (CKD) with hypertension (n=1,277). Evening dosing of antihypertensive drugs vs. Morning dosing regimen was evaluated on total events and major cardiovascular events (p=<0.001). Taking antihypertensive drugs in the evening significantly reduced total events and major cardiovascular events (P<0.001) compared to morning dosing in CKD patients with hypertension.
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