Chronotherapy With the Angiotensin-Converting Enzyme Inhibitor Ramipril in Essential Hypertension

May 13, 2009Hypertension (Dallas, Tex. : 1979)

Better blood pressure control by taking the blood pressure medicine ramipril at bedtime in high blood pressure

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Abstract

Bedtime administration of ramipril significantly improved nighttime blood pressure control in 115 untreated hypertensive patients.

Blood pressure measurements taken over 48 hours indicated that the reduction in daytime blood pressure was similar for both morning and bedtime dosing.
Bedtime administration led to a significant decrease in asleep blood pressure compared to morning dosing.
The awake:asleep blood pressure ratio improved, showing a more pronounced dipping pattern with bedtime dosing.
The proportion of patients achieving controlled ambulatory blood pressure increased from 43% to 65% with bedtime treatment (P=0.019).
Nocturnal blood pressure regulation is associated with a lower cardiovascular risk than daytime values.

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Clinical studies have demonstrated a different effect on blood pressure of some angiotensin-converting enzyme inhibitors when administered in the morning versus the evening. Their administration at bedtime resulted in a higher effect on nighttime blood pressure as compared with morning dosing. This study investigated the administration time-dependent effects of ramipril on ambulatory blood pressure. We studied 115 untreated hypertensive patients, 46.7+/-11.2 years of age, randomly assigned to receive ramipril (5 mg/d) as a monotherapy either on awakening or at bedtime. Blood pressure was measured for 48 hours before and after 6 weeks of treatment. The blood pressure reduction during diurnal activity was similar for both treatment times. Bedtime administration of ramipril, however, was significantly more efficient than morning administration in reducing asleep blood pressure. The awake:asleep blood pressure ratio was decreased after ramipril on awakening but significantly increased toward a more dipping pattern after bedtime dosing. The proportion of patients with controlled ambulatory blood pressure increased from 43% to 65% (P=0.019) with bedtime treatment. Nocturnal blood pressure regulation is significantly better achieved at bedtime as compared with morning administration of ramipril, without any loss in efficacy during diurnal active hours. This might be clinically important, because nighttime blood pressure has been shown to be a more relevant marker of cardiovascular risk than diurnal mean values. The change in the dose-response curve, increased proportion of controlled patients, and improved efficacy on nighttime blood pressure with administration of ramipril at bedtime should be taken into account when prescribing this angiotensin-converting enzyme inhibitor for treatment of essential hypertension.

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Chronotherapy With the Angiotensin-Converting Enzyme Inhibitor Ramipril in Essential Hypertension

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