Restoring nightly blood pressure dip by altering timing of antihypertensive therapy in CKD
Original article
Minutolo R et al. (2007) Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. Am J Kidney Dis 50: 908–917 PubMed
Individuals whose blood pressure does not drop by at least 10% at night ('nondippers') are at increased risk of cardiovascular morbidity and mortality. Nondipping status is common among patients with chronic kidney disease (CKD) and is associated with an increased risk of end-stage renal disease. Minutolo et al. investigated whether altering the timing of administration of antihypertensive drugs can restore the normal circadian rhythm of blood pressure in CKD patients.
The study enrolled 32 outpatients with CKD who had an estimated glomerular filtration rate <90 ml/min/1.73 m2, nondipper status (night:day ratio of mean ambulatory blood pressure [ABP] >0.9) and a mean ABP of <135/85 mmHg. Patients' antihypertensive treatment regimens were modified by a shift in the dosing of one antihypertensive drug (not a diuretic) from the morning to the evening.
After 8 weeks of the modified treatment regimen, 28 of 32 patients (87.5%) had achieved dipping status. The average night:day ratio of ABP decreased significantly from baseline to 8 weeks after the drug shift (from 0.95 
0.04 to 0.87 0.04; P <0.001). Mean systolic and mean diastolic office blood pressures in the morning also dropped markedly over 8 weeks (P = 0.02 for both parameters). Mean urinary protein excretion decreased significantly from 271 284 mg/day at baseline to 182 225 mg/day 8 weeks after the drug shift (P <0.001). The mean number of antihypertensive drugs taken per patient during the study was 2.4 1.4. No relationship was found between the number or type of drugs administered and the change in blood pressure following the drug shift.
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Subject areas under which this article appears: Hypertension
