Document Detail

Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD.
MedLine Citation:
PMID:  22025630     Owner:  NLM     Status:  MEDLINE    
Time of ingestion of hypertension medications can affect circadian patterns of BP, but whether this translates into an effect on clinical outcomes is unknown. Here, in an open-label trial, we randomly assigned 661 patients with CKD either to take all prescribed hypertension medications upon awakening or to take at least one of them at bedtime. We measured 48-hour ambulatory BP at baseline and 3 months after any adjustment in treatment or, at the least, annually. After a median follow-up of 5.4 years, patients who took at least one BP-lowering medication at bedtime had an adjusted risk for total cardiovascular events (a composite of death, myocardial infarction, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke) that was approximately one-third that of patients who took all medications upon awakening (adjusted HR 0.31; 95% CI 0.21 to 0.46; P < 0.001). Bedtime dosing demonstrated a similar significant reduction in risk for a composite outcome of cardiovascular death, myocardial infarction, and stroke (adjusted HR 0.28; 95% CI 0.13 to 0.61; P < 0.001). Furthermore, patients on bedtime treatment had a significantly lower mean sleep-time BP and a greater proportion demonstrated control of their ambulatory BP (56% versus 45%, P = 0.003). Each 5-mmHg decrease in mean sleep-time systolic BP was associated with a 14% reduction in the risk for cardiovascular events during follow-up (P < 0.001). In conclusion, among patients with CKD and hypertension, taking at least one antihypertensive medication at bedtime improves control of BP and reduces the risk for cardiovascular events.
Ramón C Hermida; Diana E Ayala; Artemio Mojón; José R Fernández
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-10-24
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  22     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-02     Completed Date:  2012-01-23     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2313-21     Citation Subset:  IM    
Bioengineering and Chronobiology Laboratories, E.T.S.I. Telecomunicación, Campus Universitario, Vigo (Pontevedra) 36310, Spain.
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MeSH Terms
Antihypertensive Agents / administration & dosage*,  pharmacology
Blood Pressure / drug effects
Cardiovascular Diseases / etiology*,  prevention & control*
Chronic Disease
Drug Chronotherapy*
Hypertension / complications*,  drug therapy*
Kidney Diseases / complications*
Middle Aged
Prospective Studies
Risk Factors
Reg. No./Substance:
0/Antihypertensive Agents
Comment In:
Ann Intern Med. 2012 Jun 19;156(12):JC6-8   [PMID:  22711109 ]
J Am Soc Nephrol. 2011 Dec;22(12):2152-5   [PMID:  22080422 ]
Nat Rev Nephrol. 2012 Jan;8(1):4   [PMID:  22105157 ]

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