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

摘要

Hypertension isa global public health problem,causingmany complications,especially cardiovascularevents. Thelateststudy (PURE) showed that hypertensionwas thelargest risk factorand 22.3%ofcardiovascular disease(CAD)casesand deaths wereattributed to hypertension. [1] Recentstudies haveshown that the morning blood pressuresurge wasastrong predictor ofCAD. The morning blood pressuresurge hasa significantly increased risk ofcardiovascularevents, so effectivecontrol on the morning blood pressureis ofsubstantialclinicalimportancefor the management of hypertension. In the HONEST study,cardiovascular risk was higher in patients withmorning blood pressure[BP] 145 mmHg and office BP 130 mmHg (hazard ratio [HR], 2.47; 95%confidenceinterval[CI], 1.20–5.08) than in patients withmorning home BP 125 mmHg and office BP 130 mmHg. [2] Acohortstudy showed thata 1-mmHg increaseinmorningBP wasassociated with a 2.1%increased risk ofcardiovascular death. [3,4] Multiple prospectiveclinicaltrials indicatethat improved normalization ofasleep BP and 24 hours BP patterning – increasein sleep-timerelative BP declinetoward the more normal dipper profile – when administrationwith conventionally formulated singleand combination hypertensionmedicationsat bedtimethan upon awakening, [5,6] withoutan increasein adverseeffects. [7] Compared withmorning dosing, taking antihypertensivesat bedtime nearly halvescardiovascular deaths,according to recentstudies. [5,8] In order to improve BP management,administration ofantihypertensive drugsat bedtime hasalready been taken into account for thetreatmentstrategy. Various researches focused on theinfluence oftakingmedicine before going to bed on 24 hours BP orcardiovascularevents,and proposed that ingesting at least 1 antihypertensive medication at bedtime,compared with treatment with allmedications upon awakening, gained asignificant reduction in the 24-hours mean systolic BP (SBP)/diastolic BP (DBP)and thereductionwas muchmore prominent during night time, decreasing the prevalence of non-dipping. [9–11] However, no consensus has been reached on the morning surge BP-lowering effect ofthis strategy.