Efficacy and Safety of Nighttime Dosing of Antihypertensives: Review of the Literature and Design of a Pragmatic Clinical Trial

Published

Journal Article

Blood pressure exhibits circadian variability, and nighttime blood pressure is one of the best predictors of cardiovascular (CV) events. Adults with hypertension who lack a nighttime dipping pattern are at particularly high risk. Several studies have found that bedtime dosing of antihypertensive agents reduces sleep blood pressure and improves the dipping pattern in nondippers. One small study and 2 substudies of diabetes and chronic kidney disease suggest that bedtime dosing of ≥1 antihypertensives significantly reduced CV events. A Cochrane review of 5 studies found no difference in adverse events between morning and evening dosing. However, several evaluations in ophthalmology have found that nocturnal arterial hypotension precipitated ocular vascular disorders such as ischemic optic neuropathy. Some authors have suggested that additional studies of nighttime dosing of antihypertensive agents that evaluate CV events need to be conducted. The authors describe a randomized controlled pragmatic trial that is being planned at the University of Iowa and Duke University. Patients with hypertension and other comorbid conditions will be randomized to either continue morning dosing of all antihypertensive agents or to switch their nondiuretic medications to bedtime dosing. Patients will be followed for 36 to 42 months. This study will determine whether nighttime dosing reduces CV risk when compared with traditional morning dosing of antihypertensive agents. © 2013 Wiley Periodicals, Inc.

Full Text

Duke Authors

Cited Authors

  • Carter, BL; Chrischilles, EA; Rosenthal, G; Gryzlak, BM; Eisenstein, EL; Vander Weg, MW

Published Date

  • February 1, 2014

Published In

Volume / Issue

  • 16 / 2

Start / End Page

  • 115 - 121

Electronic International Standard Serial Number (EISSN)

  • 1751-7176

International Standard Serial Number (ISSN)

  • 1524-6175

Digital Object Identifier (DOI)

  • 10.1111/jch.12238

Citation Source

  • Scopus