November 20, 2012Open Access
View Full PaperA Trial of 2 Strategies to Reduce Nocturnal Blood Pressure in Blacks With Chronic Kidney Disease
Key Result
Neither bedtime dosing (123.9 mm Hg) nor an add-on bedtime dose (123.5 mm Hg) significantly reduced nocturnal systolic BP compared with morning dosing (125.6 mm Hg) in Black patients with CKD.
Study Design
Type
RCT (n=147)
Randomization
Crossover
Structured PICO
Does bedtime dosing or adding a bedtime dose of antihypertensive medication reduce nocturnal systolic blood pressure compared to morning dosing in Black patients with hypertensive chronic kidney disease?
P
Population
147 Black adults (mean age 65.4 years, 36% female) with hypertensive chronic kidney disease and controlled office BP, undergoing three 6-week crossover treatment periods.
I
Intervention
PM dose (once-daily antihypertensives taken at bedtime) or add-on dose (once-daily antihypertensives taken in the morning plus an additional antihypertensive medication before bedtime [diltiazem 60-120 mg, hydralazine 25 mg, or additional ramipril 5 mg]) for 6 weeks each.
C
Comparator
AM dose (once-daily antihypertensive medications taken in the morning) for 6 weeks.
O
Outcome
Nocturnal systolic blood pressure measured by ambulatory BP monitoring at the end of each 6-week period.surrogate
In Black patients with hypertensive chronic kidney disease, shifting antihypertensive medications to bedtime or adding a bedtime dose did not significantly reduce nocturnal blood pressure compared to morning dosing.
Main Result
Absolute Event Rate: 123.9% vs 125.6%
p-value: p=NS
Abstract
The objective of our study was to determine the effects of 2 antihypertensive drug dose schedules (PM dose and add-on dose) on nocturnal blood pressure (BP) in comparison with usual therapy (AM dose) in blacks with hypertensive chronic kidney disease and controlled office BP. In a 3-period, crossover trial, former participants of the African American Study of Kidney Disease were assigned to receive the following 3 regimens, each lasting 6 weeks, presented in random order: AM dose (once-daily antihypertensive medications taken in the morning), PM dose (once-daily antihypertensives taken at bedtime), and add-on dose (once-daily antihypertensives taken in the morning and an additional antihypertensive medication before bedtime diltiazem 60-120 mg, hydralazine 25 mg, or additional ramipril 5 mg). Ambulatory BP monitoring was performed at the end of each period. The primary outcome was nocturnal systolic BP. Mean age of the study population (n=147) was 65.4 years, 64% were men, and mean estimated glomerular filtration rate was 44.9 mL/min per 1.73 m(2). At the end of each period, mean (SE) nocturnal systolic BP was 125.6 (1.2) mm Hg in the AM dose, 123.9 (1.2) mm Hg in the PM dose, and 123.5 (1.2) mm Hg in the add-on dose. None of the pairwise differences in nocturnal, 24-hour, and daytime systolic BP was statistically significant. Among blacks with hypertensive chronic kidney disease, neither PM (bedtime) dosing of once-daily antihypertensive nor the addition of drugs taken at bedtime significantly reduced nocturnal BP compared with morning dosing of antihypertensive medications.