Pharmacist Based Antihypertensive Medication Review and Assignment of Morning versus Evening Dosing of Once Daily Antihypertensive Medications: A Pilot Study to Assess Feasibility and Efficacy in Chronic Kidney Disease Patients

摘要

Evening dosing of antihypertensive medications lowers nighttime blood pressure and, in one large randomized trial, reduced risk for cardiovascular outcomes. However, feasibility of nighttime dosing in routine clinical practice is unknown. The purpose of this pilot study was to evaluate the effect of a brief pharmacist intervention to assign patients to take antihypertensive medications at specific times of the day. In this pilot, randomized controlled trial, 79 patients with moderate to severe CKD taking one or more antihypertensive medications once daily were randomized to take one once daily antihypertensive either in the morning or the evening. A total of 79 patients were randomized (39 to morning dosing, 40 to evening dosing). Average (SD) age was 56.5 (14) years, 68% were male, and average (SD) estimated glomerular filtration rate was 36.6 (8.9) mL/min/1.73m². Adherence, defined as taking the once daily medication at the time indicated 6 or 7 times in the last 7 days and not taking it at any other time during the day, was 91% in the morning arm and 95% in the evening arm (P=0.57). This pilot demonstrates the feasibility and efficacy of a pharmacist-physician collaborative to assign one-daily antihypertensive medications to either morning or evening dosing.