nighttime dosing of antihypertensive agents that evaluate CV events need to be .... center in Spain. Patients were .... The call had two phases: the. UH2 phase ...
ORIGINAL
PAPER
Efficacy and Safety of Nighttime Dosing of Antihypertensives: Review of the Literature and Design of a Pragmatic Clinical Trial Barry L. Carter, PharmD;1,2,3 Elizabeth A. Chrischilles, PhD;1,4 Gary Rosenthal, MD;3,5 Brian M. Gryzlak, MSW, MA;4 Eric L. Eisenstein, DBA;6 Mark W. Vander Weg, PhD3,5,7 From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA;1 Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA;2 the Iowa City Veterans Administration, Iowa City, IA;3 the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA;4 the Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA;5 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC;6 and the Department of Psychology, University of Iowa, Iowa City, IA7
Blood pressure exhibits circadian variability, and nighttime blood pressure is one of the best predictors of cardiovascular (CV) events. Adults with hypertension who lack a nighttime dipping pattern are at particularly high risk. Several studies have found that bedtime dosing of antihypertensive agents reduces sleep blood pressure and improves the dipping pattern in nondippers. One small study and 2 substudies of diabetes and chronic kidney disease suggest that bedtime dosing of ≥1 antihypertensives significantly reduced CV events. A Cochrane review of 5 studies found no difference in adverse events between morning and evening dosing. However, several evaluations in ophthalmology have found that nocturnal arterial hypotension precipitated ocular vascular disorders such as ischemic optic neuropathy.
Some authors have suggested that additional studies of nighttime dosing of antihypertensive agents that evaluate CV events need to be conducted. The authors describe a randomized controlled pragmatic trial that is being planned at the University of Iowa and Duke University. Patients with hypertension and other comorbid conditions will be randomized to either continue morning dosing of all antihypertensive agents or to switch their nondiuretic medications to bedtime dosing. Patients will be followed for 36 to 42 months. This study will determine whether nighttime dosing reduces CV risk when compared with traditional morning dosing of antihypertensive agents. J Clin Hypertens (Greenwich). 2014;16:115–121. ª2013 Wiley Periodicals, Inc.
A common strategy to improve medication adherence and improve blood pressure (BP) control is to give antihypertensive agents as a single daily dose.1 However, many antihypertensive agents do not adequately control BP throughout the entire 24-hour dosing interval.2,3 There is now renewed interest in treating hypertension with divided doses or giving some antihypertensives in the evening.4–8 The purpose of this paper is to review the literature on nighttime dosing of antihypertensives. We will also describe a pragmatic clinical trial currently being designed to compare cardiovascular (CV) events between conventional dosing and nighttime dosing of BP medications.
dipping and is defined as a drop in systolic BP ≥10%. Normal nighttime BPs are
