Comparison of effects of angiotensin II receptor blocker on morning home blood pressure and cardiorenal protection between morning administration and evening administration in hypertensive patients: the COMPATIBLE study

Abstract

Whether the time of administering the angiotensin receptor antagonist olmesartan influences antihypertensive and renoprotective effectiveness remains unclear. This study compared the effects of olmesartan on morning home blood pressure (MHBP), office BP (OBP) and renoprotective parameters between morning and evening administration. A total of 218 patients with primary hypertension were randomly assigned to receive olmesartan once daily in the morning (morning-dose group) or evening (evening-dose group), and 188 completed the study protocol (morning-dose group, n=95; evening-dose group, n=93). In both groups, morning home systolic BP, morning home diastolic BP, office systolic BP and office diastolic BP decreased significantly. There was no significant difference between the groups in MHBP or OBP after 6 months of treatment. The urinary albumin-to-creatinine ratio (UACR) decreased from 13.9 to 6.9 mg g(-1) (geometric means, P<0.001) in the morning-dose group and from 14.4 to 9.1 mg g(-1) (P<0.001) in the evening-dose group. The changes in UACR after treatment did not differ significantly between the groups. SV1+RV5 decreased significantly from baseline to 6 months in the morning-dose group (P<0.001) and the evening-dose group (P<0.01), and did not differ significantly between the groups. In conclusion, olmesartan effectively decreased MHBP, OBP, SV1+RV5 and UACR regardless of whether the drug was administered in the morning or in the evening. Our results suggest that olmesartan can be prescribed once daily, either in the morning or in the evening.

Chronotherapy for Hypertension

“…Three cross-sectional studies exploring the efficacy of taking one or more antihypertensive medications at night indicate that bedtime antihypertensive medication reduces asleep SBP, DBP and prevalence of non-dipping, and improves 24-h BP control (82–84). A smaller RCT of ARB, found no significant effects of treatment timings on morning home BP or office BP based (85). However, this study did not include overnight or sleep measures of BP and included use of various other medications concurrently.…”

Different chronotherapeutic effects of valsartan and olmesartan in non-dipper hypertensive patients during valsartan treatment at morning

“…Some research groups (18,19) found that, compared with morning dosing, evening dosing of olmesartan was a better dose regimen for the treatment of hypertension, whereas other research groups (20,21) did not support the merits of chronotherapy of olmesartan. In this study, the percent of dipper BP pattern was similar between the olmesartan-M (46%) and olmesartan-E (42%) groups, which suggests that the influence of a dosing-time of olmesartan on BP dipping state was small in hypertensive patients with a non-dipper BP pattern during valsartan treatment at morning.…”

Difference in the effects of switching from Candesartan to Olmesartan or Telmisartan to Olmesartan in hypertensive patients with type 2 diabetes: the COTO study

“…Also, the intensified inhibitory effect on urinary albumin excretion was suggested to be independent of the circadian variation in BP. Nevertheless, in the recent study16 of olmesartan that similarly compared evening dosing with morning dosing, olmesartan was suggested to show a well-sustained antihypertensive effect independent of dosing time when given once daily. That is, olmesartan significantly reduced the urinary albumin:Cr ratio when given in the morning or in the evening, but there was no significant difference in the reduction of this ratio between the morning and evening dosing groups.…”