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Clinical Research
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Bedtime Dosing of Antihypertensive Medications Reduces Cardiovascular Risk in CKD

Ramón C. Hermida, Diana E. Ayala, Artemio Mojón and José R. Fernández
JASN December 2011, 22 (12) 2313-2321; DOI: https://doi.org/10.1681/ASN.2011040361
Ramón C. Hermida
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Diana E. Ayala
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Artemio Mojón
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José R. Fernández
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Abstract

Time of ingestion of hypertension medications can affect circadian patterns of BP, but whether this translates into an effect on clinical outcomes is unknown. Here, in an open-label trial, we randomly assigned 661 patients with CKD either to take all prescribed hypertension medications upon awakening or to take at least one of them at bedtime. We measured 48-hour ambulatory BP at baseline and 3 months after any adjustment in treatment or, at the least, annually. After a median follow-up of 5.4 years, patients who took at least one BP-lowering medication at bedtime had an adjusted risk for total cardiovascular events (a composite of death, myocardial infarction, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke) that was approximately one-third that of patients who took all medications upon awakening (adjusted HR 0.31; 95% CI 0.21 to 0.46; P < 0.001). Bedtime dosing demonstrated a similar significant reduction in risk for a composite outcome of cardiovascular death, myocardial infarction, and stroke (adjusted HR 0.28; 95% CI 0.13 to 0.61; P < 0.001). Furthermore, patients on bedtime treatment had a significantly lower mean sleep-time BP and a greater proportion demonstrated control of their ambulatory BP (56% versus 45%, P = 0.003). Each 5-mmHg decrease in mean sleep-time systolic BP was associated with a 14% reduction in the risk for cardiovascular events during follow-up (P < 0.001). In conclusion, among patients with CKD and hypertension, taking at least one antihypertensive medication at bedtime improves control of BP and reduces the risk for cardiovascular events.

  • Copyright © 2011 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 22 (12)
Journal of the American Society of Nephrology
Vol. 22, Issue 12
1 Dec 2011
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Bedtime Dosing of Antihypertensive Medications Reduces Cardiovascular Risk in CKD
Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández
JASN Dec 2011, 22 (12) 2313-2321; DOI: 10.1681/ASN.2011040361

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Bedtime Dosing of Antihypertensive Medications Reduces Cardiovascular Risk in CKD
Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández
JASN Dec 2011, 22 (12) 2313-2321; DOI: 10.1681/ASN.2011040361
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More in this TOC Section

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  • Advance Care Planning in Older Adults with CKD: Patient, Care Partner, and Clinician Perspectives
  • Defects in KCNJ16 Cause a Novel Tubulopathy with Hypokalemia, Salt Wasting, Disturbed Acid-Base Homeostasis, and Sensorineural Deafness
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Cited By...

  • Diabetes and Hypertension: A Position Statement by the American Diabetes Association
  • Sleep-Time Ambulatory BP Is an Independent Prognostic Marker of CKD
  • Chronotherapy for hypertension in obstructive sleep apnoea (CHOSA): a randomised, double-blind, placebo-controlled crossover trial
  • The chronotherapy of hypertension: or the benefit of taking blood pressure tablets at bedtime
  • Effects of Sacubitril/Valsartan (LCZ696) on Natriuresis, Diuresis, Blood Pressures, and NT-proBNP in Salt-Sensitive Hypertension
  • Nighttime BP in Elderly Individuals with Prediabetes/Diabetes with and without CKD: The HEIJO-KYO Study
  • Hypertension: A Disease That Strikes Around the Clock
  • Methods of a large prospective, randomised, open-label, blinded end-point study comparing morning versus evening dosing in hypertensive patients: the Treatment In Morning versus Evening (TIME) study
  • A Young Patient with a Family History of Hypertension
  • Diurnal Variation in Blood Pressure and Arterial Stiffness in Chronic Kidney Disease: The Role of Endothelin-1
  • A Trial of 2 Strategies to Reduce Nocturnal Blood Pressure in Blacks With Chronic Kidney Disease
  • Taking blood pressure-lowering medications at night
  • Chronotherapy in Hypertension: A Pill at Night Makes Things Right?
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