Hypertension (Dallas, Tex. : 1979)Sep 8, 2005

Lower urinary albumin levels linked to nighttime blood pressure returning to normal in people with high blood pressure

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 29, 2026

Abstract

The diurnal/nocturnal blood pressure ratio increased significantly from 7.5 to 12.2 with bedtime valsartan administration.

Bedtime administration of valsartan (160 mg/d) reduced urinary albumin excretion by 41% in nonproteinuric patients.
The reduction in urinary albumin was independent of the overall 24-hour blood pressure decrease.
A significant correlation was observed between the decrease in nocturnal blood pressure and the increase in the diurnal/nocturnal blood pressure ratio.
Bedtime valsartan treatment improved the circadian blood pressure pattern to a more dipper profile.
This normalization of blood pressure patterns could be associated with decreased cardiovascular risk in nondipper hypertensive patients.

Simplified

Previous results have indicated that valsartan administration at bedtime as opposed to on wakening improves the diurnal/nocturnal ratio of blood pressure without loss in efficacy and therapeutic coverage. We hypothesized that increasing this ratio could reduce microalbuminuria. We conducted a prospective, randomized, open-label, blinded endpoint trial on 200 previously untreated nonproteinuric patients with grade 1 to 2 essential hypertension, assigned to receive valsartan (160 mg/d) as a monotherapy either on awakening or at bedtime. Blood pressure was measured by ambulatory monitoring for 48 consecutive hours before and after 3 months of treatment. Physical activity was simultaneously monitored every minute by wrist actigraphy to accurately calculate the diurnal and nocturnal means of blood pressure on a per-subject basis. The significant blood pressure reduction after 3 months of therapy was similar for both treatment times. The diurnal/nocturnal blood pressure ratio was unchanged after valsartan on awakening, but significantly increased from 7.5 to 12.2 (P<0.001) when valsartan was administered at bedtime. Urinary albumin excretion was significantly reduced by 41% after bedtime treatment. This reduction was independent of the 24-hour blood pressure decrease but highly correlated with the decrease in nocturnal blood pressure and mainly with the increase in diurnal/nocturnal ratio (P<0.001). Bedtime valsartan administration improves the diurnal/nocturnal blood pressure ratio to a more dipper profile. This normalization of the circadian blood pressure pattern is associated with a significant decrease in urinary albumin excretion and plasma fibrinogen, and could thus reduce the increased cardiovascular risk in nondipper hypertensive patients.

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Lower urinary albumin levels linked to nighttime blood pressure returning to normal in people with high blood pressure

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