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Hypertens Res. 2018 May;41(5):342-353. doi: 10.1038/s41440-018-0029-1. Epub 2018 Mar 12.

Risk of incident chronic kidney disease is better reduced by bedtime than upon-awakening ingestion of hypertension medications.

Author information

1
Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Campus Universitario, Vigo, 36310, Spain. rhermida@uvigo.es.
2
Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Campus Universitario, Vigo, 36310, Spain.

Abstract

This trial investigated whether therapy with the entire daily dose of ≥1 hypertension medications at bedtime exerts a greater reduction in the risk of incident chronic kidney disease (CKD) than therapy with all medications upon awakening. We conducted a prospective, open-label, blinded endpoint trial of 2078 hypertensive patients without CKD (1017 men/1061 women, 53.6 ± 13.7 years of age) randomized to ingest all their prescribed hypertension medications upon awakening (n = 1041) or the entire daily dose of ≥1 of those medications at bedtime (n = 1037). During a 5.9-year median follow-up, 368 participants developed CKD. Patients of the bedtime, compared with the morning, treatment group showed (i) significantly lower asleep blood pressure (BP) mean, greater sleep-time relative BP decline, and attenuated prevalence of non-dipping at the final evaluation (38 vs. 55%; P < 0.001); and (ii) a significantly lower hazard ratio of CKD, adjusted for the significant influential characteristics of age, serum creatinine, urinary albumin, type 2 diabetes, previous cardiovascular event, asleep systolic BP mean, and sleep-time relative systolic BP decline (0.27 (95% confidence interval: 0.21-0.36); event-rate 8.3 vs. 27.1% in the bedtime and morning-treatment groups; P < 0.001). Greater benefit was observed for bedtime than awakening treatment, with angiotensin converting enzyme inhibitors and angiotensin receptor blockers. In hypertensive patients without CKD, ingestion of ≥1 BP-lowering medications at bedtime, mainly those modulating or blocking the effects of angiotensin II, compared with ingestion of all such medications upon-awakening, resulted in improved ambulatory BP control (significant further decrease of asleep BP and enhanced sleep-time relative BP decline) and reduced risk of incident CKD.

PMID:
29531290
DOI:
10.1038/s41440-018-0029-1

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