Key result
Bedtime administration of 60 mg/d nifedipine GITS yielded a larger reduction in 24-hour mean systolic and diastolic BP than morning dosing (16.0/9.3 vs 8.4/4.0 mm Hg; P<0.03) and reduced edema by 91%.
Why the study?
Does bedtime administration of nifedipine GITS improve blood pressure reduction and reduce side effects compared to morning administration in patients with essential hypertension?
RCT (n=80)
randomly assigned
Does bedtime administration of nifedipine GITS improve blood pressure reduction and reduce side effects compared to morning administration in patients with essential hypertension?
p-value: p=<0.03
Bedtime administration of nifedipine GITS provides superior blood pressure reduction at higher doses and significantly fewer side effects compared to morning dosing in patients with essential hypertension.
Favors bedtime nifedipine GITS dosing to optimize BP control and minimize edema; extends chronotherapy evidence in hypertension.
Several studies have shown that the circadian pattern of blood pressure (BP) remains unchanged after either morning or evening dosing of several CCB, including amlodipine, isradipine, verapamil, nitrendipine, and cilnidipine. A previous trial on a very small number of patients (n=10) concluded that the time of administration of 30 mg/d nifedipine gastrointestinal therapeutic system (GITS) has no impact on therapeutic efficacy [Clin Investig. 1994;72:864–869]. We investigated the antihypertensive efficacy and effects on the circadian BP pattern of nifedipine GITS in doses of 30 and 60 mg/d administered at different times according to the rest-activity cycle of each patient. We studied 80 previously untreated patients with grade 1–2 essential hypertension (36 men and 44 women), 52.1±10.7 years of age, randomly assigned to receive nifedipine GITS (30 mg/d) as a monotherapy for 8 weeks either upon awakening or at bedtime. Uncontrolled patients were titrated to receive 60 mg/d nifedipine GITS for another 8 weeks. BP was measured at 20-min intervals from 07:00 to 23:00 hours and at 30-min intervals at night for 48 hours before and after every 8 weeks of therapy. The BP reduction after 8 weeks of therapy with the lower dose of 30 mg/d was slightly but not significantly larger after bedtime dosing (10.3 and 6.5 mm Hg reduction in the 24-hour mean of systolic and diastolic BP after nifedipine GITS on awakening; 12.0 and 7.2 mm Hg after bedtime dosing). In non-responders to this low dose, the efficacy of 60 mg/d nifedipine GITS was markedly larger after bedtime dosing (16.0 and 9.3 mm Hg in systolic and diastolic BP, as compared to 8.4 and 4.0 mm Hg after morning dosing; P<0.03). Moreover, bedtime administration of nifedipine GITS reduced the incidence of edema by 91% and the total number of secondary effects by 74% as compared to morning dosing (P=0.02). Independently of the time of administration, a single daily dose of 30 mg/d of nifedipine GITS efficiently reduces BP for the whole 24 hours of the day. The added efficacy with 30 mg/d, the marked benefits with 60 mg/d, and the safety profile of bedtime administration of nifedipine GITS should be taken into account when prescribing this CCB in the treatment of essential hypertension.
No takes yet. Share an insight, caveat, or question.
Hermida et al. (2005) conducted an RCT in essential hypertension (n=80). nifedipine GITS bedtime dosing vs. nifedipine GITS morning dosing was evaluated on Reduction in 24-hour mean systolic and diastolic blood pressure (p=<0.03). Bedtime administration of 60 mg/d nifedipine GITS yielded a larger reduction in 24-hour mean systolic and diastolic BP than morning dosing (16.0/9.3 vs 8.4/4.0 mm Hg; P<0.03) and reduced edema by 91%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: