Time-Dependent Drug Administration in Hypertension and its Effect on Blood Pressure Variability

Background: Optimizing blood pressure variability seems to represent a new therapeutic target in the management of hypertension. It is emphasized that scheduling at least one antihypertensive agent at bedtime, has the ability to reduce blood pressure. Aim of the study: We have proposed to test whether the divided treatment regimen also lowers blood pressure variability. Material and methods: A number of 37 treated hypertensive patients were enrolled, who underwent 24-hour ambulatory blood pressure monitoring (ABPM) at inclusion and at 8 weeks after therapeutic intervention with divided treatment regimen. BPV was assessed using average real variability. Results: The 24-hour systolic blood presure decreased from 139.5 ± 8.8 mmHg to 127.4 ± 8.9 mmHg (p <0.0001), and we noted a 2.1 mmHg drop in blood pressure variability (p <0.0001), as well as a two-fold increase in the percentage of dippers. After baseline ABPM assessment, in 15 cases an angiotensin-converting-enzyme-inhibitor was scheduled at bedtime, and in 10 cases it was given twice a day. In 17 cases a thiazide diuretic was administered in the afternoon, and in 18 cases a calcium channel blocker was administered at bedtime. Conclusions: For a more accurate management of patients with hypertension, the assessment of circadian blood pressure profile and the implementation of an individualized treatment that uses divided antihypertensive agents at bedtime or midday administration have the ability to optimize blood pressure control, restore dipper-profile, and decrease blood pressure variability.