Comparison of the antihypertensive efficacy of morning and bedtime dosing on reducing morning blood pressure surge

Zhang, Peng; Jin, Mingyue; Song, Xu-Yu; Wang, Zhao; Jiang, Yuehua; Yang, Chuanhua

doi:10.1097/md.0000000000024127

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…For EHT and MoEHT groups, the independently associated clinical factor was taking at least 1 long-acting antihypertensive drug once daily in the morning. Antihypertensive drugs were an important factor in home BP control since previous studies of chronotherapy of hypertension indicated that evening or bedtime administration of antihypertensive drugs improved morning BP control [36][37][38]. Because of the long duration of action of antihypertensive drugs that were taken in the morning, the evening home BP was controlled to achieve the BP target.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Characteristics including Patterns of Antihypertensive Drug Administration of the Different Home Blood Pressure Phenotypes in Treated Hypertensive Patients

Chotruangnapa

Thammarux

Thongdang

2022

International Journal of Hypertension

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Quality and quantity of home blood pressure (BP) control are important for optimizing hypertensive treatment. The prevalence and associated clinical characteristics of the different home blood pressure phenotypes in treated hypertensive patients were not elucidated. This study was conducted in Siriraj Hospital, Thailand from 2019 to 2020. We included treated hypertensive patients with ≥1 antihypertensive drug and had self-home BP measurement data. Both traditional (office BP < 140/90 mmHg and home BP < 130/80 mmHg) and new BP targets (office and home BP < 130/80 mmHg) were used for the classification of BP phenotypes. Home BP phenotypes consisted of controlled hypertension (all home BPs achieved home BP targets), isolated uncontrolled morning hypertension (MoHT) (only morning BP was above home BP targets), isolated uncontrolled evening hypertension (EHT) (only evening BP was above home BP targets), and combined morning-evening uncontrolled hypertension (MoEHT) (all home BPs were above home BP targets). Our study included 1,406 patients. The total mean age was 62.94 ± 13.97 years. There were 39.40% men. The prevalence of each home BP phenotype (by traditional BP target) was 55.76%, 12.66%, 7.40%, and 24.18% in controlled (home) hypertension, MoHT, EHT, and MoEHT, respectively. Classical BP control status was 35.21% well-controlled hypertension, 30.01% white-coat uncontrolled hypertension, 9.74% masked uncontrolled hypertension, and 25.04% sustained uncontrolled hypertension. The multivariable analysis showed the significantly associated factor of MoHT was the presence of previous cardiovascular disease (adjusted OR 5.54, 95% CI (2.02–15.22); p value = 0.001). Taking once-daily long-acting antihypertensive drugs in the morning were significantly associated with both EHT (adjusted OR 0.20, 95% CI (0.05–0.82); p value = 0.025) and MoEHT (adjusted OR 0.20, 95% CI (0.04–1.00); p value = 0.049). These results were consistent in groups classified by new home BP target <130/80 mmHg.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Characteristics including Patterns of Antihypertensive Drug Administration of the Different Home Blood Pressure Phenotypes in Treated Hypertensive Patients

Chotruangnapa

Thammarux

Thongdang

2022

International Journal of Hypertension

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“…Two researchers independently carried out these searches and any disagreements were resolved by discussion. The search strategy adopted in this study (10).…”

Section: Search Strategymentioning

confidence: 99%

Bedtime administration of antihypertensive medication can reduce morning blood pressure surges in hypertensive patients: a systematic review and meta-analysis

et al. 2021

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Background: The risk of cardiovascular and cerebrovascular events is the highest during the first several hours post-awakening in patients with hypertension. This is largely due to surges in morning blood pressure (BP). The current meta-analysis explored whether morning BP is affected by the timing of antihypertensive drug administration.Methods: Four medical databases were searched for clinical trials that examined the relationship between the timing of antihypertensive drug administration and morning BP levels. This meta-analysis compared morning BP surges in patients administered medication at bedtime versus patients administered medication during the day. Results:The random effects model demonstrated that bedtime administration of antihypertensive drugs reduced morning systolic blood pressure (SBP) by 1.17 mmHg [with 95% confidence interval (CI): −2.47 to 0.37; P=0.08), and reduced morning diastolic blood pressure (DBP) by 0.95 mmHg (95% CI: −2.03 to 0.13; P=0.08), compared with patients who were administered medication during the daytime hours. However, the results did not demonstrate statistical significance. There was strong heterogeneity in both morning SBP (I 2 =77.9% >50%, and Q test >0.1) and morning DBP results (I 2 =77.9% >50%, and Q test >0.1). The funnel plots showed no publication bias in this study.Discussion: Studies have shown that a 1 mmHg change was sufficient to reduce the risk of cardiovascularrelated deaths by 2.1%. Therefore, changing the time of taking antihypertensive medications may significantly reduce cardiovascular-associated mortality. There were certain limitations to this meta-analysis.First, the heterogeneity of the meta-analysis was strong, with undefined reasons. Second, the sample size was relatively small, and future studies involving larger cohorts are warranted to further assess the effects of bedtime antihypertensive medication on minimizing morning BP surges.

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“…Morning hypertension is influenced by the sympathetic nervous system, the reninangiotensin system, and cortisol secretion. (23,24) In normal individuals, this occurs physiologically, causing increased blood flow and shear stress. (25,26) If there is vascular stenosis due to atherosclerosis, platelet aggregation and activation of plasminogen activator inhibitor 1 (PAI-1) occur.…”

Section: Mechanism Of Morning Hypertensionmentioning

confidence: 99%

Morning hypertension for stroke and cardiovascular: clinical pearls for primary care

Rasyid

Wiyarta

2021

Universa Medicina

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Hypertension is the world’s leading cause of mortality and morbidity. One of the phenomena that commonly occur in hypertensive as well as normotensive patients, is morning hypertension. Blood pressure (BP) follows a diurnal rhythm, reaching its highest level during the morning hours and dropping to the lowest level at midnight. Transient increases in BP in morning hypertension plus persistent stressors within 24 hours are thought to increase target organ damage and trigger cardiovascular events. Therefore, ambulatory BP monitoring or morning home BP monitoring is recommended as a strong predictor of cardiovascular events. There are two types of morning hypertension according to its underlying mechanisms; the first one is called nocturnal hypertensive morning hypertension, and the other one is morning-surge hypertension. Numerous studies have proved that this phenomenon often leads to several acute cardiovascular events, such as stroke, coronary artery disease, and peripheral artery disease. To prevent these complications, cost-effective management is needed, especially for identifying accurate diagnostic tools, as well as creating specific regimens. Therefore, to achieve appropriate management of hypertension, including morning hypertension, long-acting antihypertensive drugs should be used, at full doses and in the form of combination therapy. The clinical usefulness of antihypertensive drugs with specific mechanisms for morning BP or split or timed dosing of long-acting drugs in controlling morning BP remains under investigation. More studies are needed, especially looking for other clinical evidence of the benefits of lowering BP in the morning. Home BP monitoring is recommended as a good choice for BP measurements, especially in the primary care setting.

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Comparison of the antihypertensive efficacy of morning and bedtime dosing on reducing morning blood pressure surge

Cited by 5 publications

References 25 publications

Prevalence and Clinical Characteristics including Patterns of Antihypertensive Drug Administration of the Different Home Blood Pressure Phenotypes in Treated Hypertensive Patients

Prevalence and Clinical Characteristics including Patterns of Antihypertensive Drug Administration of the Different Home Blood Pressure Phenotypes in Treated Hypertensive Patients

Bedtime administration of antihypertensive medication can reduce morning blood pressure surges in hypertensive patients: a systematic review and meta-analysis

Morning hypertension for stroke and cardiovascular: clinical pearls for primary care

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