Bedtime administration of long-acting antihypertensive drugs restores normal nocturnal blood pressure fall in nondippers with essential hypertension

May 19, 2009Clinical and experimental nephrology

Taking long-lasting blood pressure medicine at bedtime helps restore normal nighttime blood pressure drop in people whose blood pressure does not normally fall at night

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Abstract

Changing the time of antihypertensive drug administration from morning to bedtime increased the percentage of patients classified as dippers from 0% to 71%.

Among 71 patients, 35 were identified as nondippers before the intervention.
Shifting medication to bedtime did not alter office or 24-hour ambulatory blood pressure but resulted in a significant decrease in nocturnal blood pressure.
The percentages of nocturnal decline in systolic and diastolic blood pressure increased significantly, from 2.6% to 15.5% and from 5.6% to 16.9%, respectively (P < 0.0001).
Morning blood pressure between 7 a.m. and 11 a.m. remained unchanged after the shift to bedtime dosing.
Overall, 86% of patients became dippers when medication timing was adjusted according to their initial dipper status.

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BACKGROUND: Nondipper hypertensive patients have more pronounced target organ injury. We examined whether shifting the time of dosing long-acting antihypertensive drugs from morning to bedtime reduces nocturnal blood pressure (BP) and restores normal nocturnal dipping in nondippers with essential hypertension.

METHODS: We studied 71 Japanese hypertensive patients who received long-acting antihypertensive drugs once daily in the morning using 24-h ambulatory BP monitoring. After determination of circadian BP pattern, medication time was changed to bedtime only in nondippers.

RESULTS: Among 71 patients, 36 were classified as dippers and 35 as nondippers. After shifting administration time from morning to bedtime in 34 nondippers, the office and 24-h ambulatory BP did not change, but the diurnal BP slightly increased and nocturnal BP markedly decreased. The percentages of nocturnal decline in systolic and diastolic BP increased from 2.6% to 15.5% (P < 0.0001) and 5.6% to 16.9% (P < 0.0001). Morning BP at 7 a.m.-11 a.m. did not increase by bedtime administration. The frequency of dippers increased from 0/34 (0%) to 24/34 (71%). Adding to 50% of dippers on morning administration, 86% of the hypertensive patients became dippers by deciding the medication time according to dipper status.

CONCLUSION: Nondippers on morning dosing can be changed to dippers by shifting administration time to bedtime, reducing nocturnal BP but not changing office BP, 24-h ambulatory BP or morning BP. In treating essential hypertensive patients, it is desirable to measure 24-h ambulatory BP as well as office BP and to decide the administration time of long-acting antihypertensive drugs to normalize nocturnal BP fall.

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Bedtime administration of long-acting antihypertensive drugs restores normal nocturnal blood pressure fall in nondippers with essential hypertension

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