Evening -Versus Morning- Dosing Drug Therapy for Chronic Kidney Disease Patients with Hypertension: A Systematic Review

Abstract

Background/Aims: There is a strong correlation between non-dipping status and cardiovascular events in chronic kidney disease (CKD) patients. Our study is designed to identify the effect of evening administration of antihypertensive drugs to hypertensive CKD patients. Methods: A comprehensive search of Medline, Embase, the Chinese Biomedical Literature Database, Wanfang Data, Chinese National Knowledge Infrastructure, and the Cochrane Central Register of Controlled Trials was performed in July 2014. Concurrent controlled or crossover trials (including randomized and non-randomized experimental trials) designed to evaluate the effects of evening- versus morning-dosing hypertensive drug regimens on clinical outcomes in CKD patients with hypertension were included. All statistical analyses were performed using the RevMan software, which is available free from the Cochrane Collaboration. Results: Seven trials involving 1277 patients were identified, and the randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were classified into two groups. Taking at least one blood pressure-lowering medication at bedtime was not shown to reduce total death (P=0.056) or cardiovascular death (P=0.059) but was shown to reduce total events (P<0.001) and major cardiovascular events (P<0.001) in both RCTs and non-RCTs. Compared with a morning dosing regimen, taking antihypertensive drug in the evening significantly lowered nighttime systolic blood pressure (SBP) (P<0.0001) and diastolic blood pressure (P<0.05) in patients in the RCTs but did not affect blood pressure in patients in the non-RCTs (P<0.05). There is limited evidence from one non-RCT that taking an antihypertensive drug (benazepril 10 mg) in the evening did not increase adverse events (P=0.72) or withdrawals due to adverse events (P=0.64). Conclusions: A regimen of antihypertensive drugs in the evening should be considered for CKD patients with hypertension to lower nighttime blood pressure and help prevent total events and cardiovascular mortality. More studies are needed to verify the results of this study. i 2015 S. Karger AG, Basel

Methods of a large prospective, randomised, open-label, blinded end-point study comparing morning versus evening dosing in hypertensive patients: the Treatment In Morning versus Evening (TIME) study

“…Further studies are needed to establish the optimal time of dosing for hypertensive patients. 17 18 Therefore, the present study aims to substantiate the findings of the MAPEC study and test the hypothesis that nocturnal dosing of antihypertensive medication reduces cardiovascular events compared with conventional morning dosing. Secondary questions will examine whether there are any downsides to nocturnal dosing and if nocturnal dosing is acceptable to patients, for example, whether nocturnal dosing of diuretics causes unacceptable nocturia will be evaluated.…”

Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti‐hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial

“…Tailoring of anti-hypertensive medications to the circadian variation of BP, or chronotherapy, has been utilized as a means of reducing nocturnal BP and converting non-dippers back to the normal dipping pattern in adults. 14,[16][17][18][19] Chronotherapy is the practice of administering medications in synchrony with circadian patterns in order to maximize health benefit while minimizing adverse effects. 20 Chronotherapy of hypertension can be accomplished by the specific timing of conventional anti-hypertensive medications based on individual needs.…”

Chronotherapy for Hypertension

“…However, to date, studies that consider chronotherapy in CKD patients are limited and with mixed effects. Two systematic reviews conducted between 2013 and 2017 suggest that administration of antihypertensive medications in the evening should be considered for CKD patients with HTN to lower nighttime SBP and/or DBP (160, 161), reduce non-dipping (161), and prevent adverse CV events and mortality (160). Table 2 summarizes 4 original studies of the effects of time-dependent dosing for treatment of HTN in patients with HTN and CKD.…”