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Effect of Chronotherapy of Antihypertensives in Chronic Kidney Disease: A Randomized Control Trial
Vaibhav Tiwari1, Arpita Ray Chaudhary2, Sanjay Dasgupta2
1Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India.
Insights
Shifting antihypertensive medication to bedtime improved blood pressure patterns in hypertensive chronic kidney disease (CKD) patients. This nighttime dosing also helped slow the decline in estimated glomerular filtration rate (eGFR) over one year.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hypertensive chronic kidney disease (CKD) patients often exhibit a non-dipping blood pressure pattern.
- Nocturnal hypertension is a significant predictor of cardiovascular events, often more so than daytime readings.
Purpose of the Study:
- To investigate the impact of administering antihypertensive medications at bedtime on the blood pressure profile of patients with CKD stages 3-4.
- To assess whether nighttime dosing can convert non-dippers to dippers and influence renal function and cardiac structure.
Main Methods:
- A single-center, prospective, randomized controlled trial involving adult patients (18-65 years) with CKD stages 3-4 and non-dipping patterns.
- Participants were randomized to receive all antihypertensives at bedtime (intervention group) or in the morning (standard care group).
- Outcomes included the conversion rate from non-dippers to dippers, changes in estimated glomerular filtration rate (eGFR), and cardiac structure over a 1-year follow-up.
Main Results:
- 26% of patients in the intervention group shifted from non-dippers to dippers, compared to none in the standard care group.
- The intervention group experienced a significantly slower decline in eGFR over one year, with a between-group difference of 5.22 mL/min/1.73 m² (P=0.03).
- No significant changes in cardiac structure were observed in either group.
Conclusions:
- Administering antihypertensive medications at bedtime is effective in converting non-dippers to dippers in CKD stages 3-4.
- Nighttime antihypertensive dosing helps preserve renal function, indicated by a slower decline in eGFR compared to morning dosing.
Introduction:
There is a higher prevalence of non-dipping pattern in hypertensive chronic kidney disease (CKD) patients. Nocturnal hypertension has been shown to predict cardiovascular mortality and morbidity and is often superior to daytime blood pressure. We studied the effect of shifting or adding antihypertensive to night time on blood pressure profile of CKD III-IV patients.
Methods:
In this single-center, prospective, randomized controlled trial, eligible participants were adults from eastern India aged 18-65 years with CKD stages 3 and 4, with a non-dipping pattern on ambulatory blood pressure monitor (ABPM). The intervention group received all the antihypertensives in the night time whereas the standard care group continued to take the medication in the morning. Both groups were followed up for 1 year. The primary outcome was the number of patients changed from non-dippers to dippers in the standard care group and intervention group. Secondary outcomes included a change in estimated glomerular filtration rate (eGFR) and change in the cardiac structure.
Results:
39 patients in the intervention group and 36 patients in the standard care group were analyzed. 10 patients (26%) reverted to dipping pattern in the intervention group as compared to none in the standard care group. Mean changes in eGFR were -2.55 and -0.18 mL/min/1.73 m2 in the standard care and intervention group at the end of the study, respectively. Between-group difference in eGFR was significant at 1 year (5.22 [95% CI, 4.3-6.1] ml/min/1.73 m2); (P = 0.03). The cardiac structure showed no significant changes in either group.
Conclusions:
Bedtime administration of antihypertensives reverted non-dippers to dippers and slowed the decline in eGFR in CKD stages 3 and 4 compared to morning administration of antihypertensives.
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