Key result
Titrating evening doses of anti-hypertensive medications based on nighttime home blood pressure monitoring was feasible, with patients providing adequate nighttime readings in 77.5% of follow-ups.
Why the study?
The feasibility of titrating evening antihypertensive medication dosing based on nighttime home blood pressure measurement readings in primary care hypertensive patients was unknown.
Does titrating evening anti-hypertensive medications based on nighttime home blood pressure monitoring improve blood pressure control and prove feasible compared to daytime monitoring in patients with nocturnal hypertension?
RCT (n=78)
Single-blind (statistician)
Stratified block randomisation
No
Does titrating evening anti-hypertensive medications based on nighttime home blood pressure monitoring improve blood pressure control and prove feasible compared to daytime monitoring in patients with nocturnal hypertension?
Titrating evening anti-hypertensive medications based on nighttime home blood pressure monitoring is a feasible and well-tolerated strategy that yields non-inferior blood pressure control compared to standard daytime monitoring.
Nighttime HBPM-guided titration is feasible in primary care; leaves open efficacy trials for nocturnal hypertension.
Background: This trial assessed the feasibility of titrating evening dosing of anti-hypertensive medications based on nighttime home blood pressure measurement (HBPM) readings in primary care for hypertensive (HT) patients. Methods: 78 patients with nocturnal HT and stage I daytime HT were randomly assigned in a 1:1 ratio to either nighttime HBPM measurements (intervention group) or daytime HBPM measurements (control group). Nighttime blood pressure (BP) was measured 3x per night for at least two nights over 1 week using an automatic and validated HBPM device. The intervention group and control group aimed to achieve systolic BP <120 mmHg on nocturnal HBPM and systolic BP <135 mmHg on daytime HBPM respectively. All patients were seen every four weeks and followed the same drug titration algorithm. Results: The trial achieved a recruitment rate of 6.5 persons per month and a retention rate of 96.1%. In the intervention group, patients provided ≥6 (considered adequate) and ≥9 nighttime HBPM readings for 77.5% and 63.8% of their follow-ups, respectively. At 6-month, both groups had similar nighttime, 24-hour, and daytime BP on ambulatory BP monitoring, as well as similar numbers of non-dippers and healthcare utilisation. Most patients reported that they learned more from their HBPM nighttime readings and found the intervention well-tolerated. Conclusion: Adjusting evening dosage of anti-HT medications based on nighttime HBPM is a potential and feasible treatment approach for patients with nocturnal HT in primary care. This approach is well-accepted by patients and results in at least non-inferior BP control. Although titrating medications according to nighttime HBPM readings may improve nighttime BP, the small sample size limited statistical significance and the single-centre design restricted generalizability. Additionally, a few patients exhibited fair adherence to nighttime HBPM. Further randomised controlled trials are required to confirm that targeting nocturnal BP should be the primary treatment goal for HT.
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Lee et al. (2025) conducted an RCT in Nocturnal hypertension and stage I daytime hypertension (n=78). Nighttime home blood pressure measurement-guided evening medication titration vs. Daytime home blood pressure measurement-guided morning medication titration was evaluated on Compliance with nighttime HBPM schedule (≥6 readings per follow-up). Titrating evening doses of anti-hypertensive medications based on nighttime home blood pressure monitoring was feasible, with patients providing adequate nighttime readings in 77.5% of follow-ups.
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