Efficacy and safety of morning or evening antihypertensive drug administration on albuminuria in hypertensive patients: an open-label pilot randomized controlled trial

Jun 2, 2026Scientific reports

Safety and effectiveness of taking blood pressure medicine in the morning or evening on kidney protein levels in people with high blood pressure

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Abstract

Among 60 participants with albuminuria, the change in urinary albumin-creatinine ratio was -0.21 for morning dosing and -0.22 for evening dosing.

No statistically significant difference in the change of urinary albumin-creatinine ratio was found between morning and evening dosing.
The adjusted difference in log urinary albumin-creatinine ratio between dosing times was -0.01.
No significant changes were observed in blood pressure or kidney function associated with the timing of antihypertensive medication.
Safety assessments indicated no concerns regarding the treatment regimen.

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To date, little is known regarding the treatment effects of different timed-dosing antihypertensive medications among hypertensive patients with albuminuria. We aimed to investigate whether morning or evening dosing of antihypertensive medication differentially affects early changes in albuminuria.We conducted an open-label, single-center, assessor-masked, parallel-group, pilot randomized controlled trial among adult hypertensive patients with albuminuria (urinary albumin‒creatinine ratio [UACR] ≥ 30 mg/g) receiving at least one antihypertensive medication. The participants were assigned (1:1) to receive antihypertensive medications either in the morning (6:00-10:00 AM) or in the evening (6:00-10:00 PM), with a treatment follow-up at 3 months. The primary outcome was the change in the log UACR. The secondary outcomes were changes in blood pressure and kidney function. Post hoc outcomes included clinically meaningful control of outcomes.Among the 60 participants enrolled (mean age, 65.6 years; proportion of females, 51.7%; median UACR, 116.1 mg/g), 58 patients completed the trial. The absolute changes in log UACR over 3 months were - 0.21 (95% CI, -0.40 to -0.03; n = 31) for morning-dosing and - 0.22 (95% CI, -0.46 to 0.01; n = 27) for evening-dosing, with an adjusted difference of -0.01 (95% CI, -0.32 to 0.30; P = 0.955) between the groups. No statistically significant difference was observed for secondary and post hoc outcomes. No safety profile concerns were identified. Among hypertensive patients with albuminuria, chronotherapy, whether administered in the morning or evening, did not affect early treatment outcomes in terms of the UACR, blood pressure, or kidney function. Trial registration: Thai Clinical Trials Registry (TCTR); TCTR20240930002; Registration date: 30/09/2024; retrospectively registered.

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Efficacy and safety of morning or evening antihypertensive drug administration on albuminuria in hypertensive patients: an open-label pilot randomized controlled trial

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