Changing the Timing of Antihypertensive Therapy to Reduce Nocturnal Blood Pressure in CKD: An 8-Week Uncontrolled Trial
Received 9 May 2007; accepted 18 July 2007. published online 21 September 2007.
Refers to article:
Should Reducing Nocturnal Blood Pressure Be a Therapeutic Target in CKD? The Time Is Ripe for a Clinical Outcomes Trial
Mahboob Rahman, Lawrence J. Appel
American Journal of Kidney Diseases
December 2007 (Vol. 50, Issue 6, Pages 901-903) Full Text |
Full-Text PDF (84 KB)
Background
Nondipping status is associated with greater cardiovascular morbidity and mortality and faster progression of chronic kidney disease (CKD). We examined whether shifting 1 antihypertensive drug from morning to evening restores the circadian rhythm of blood pressure in nondipper patients with CKD.
Study Design
8-week clinical trial without a control group.
Setting & Participants
We selected from our outpatient renal clinic 32 patients with CKD with estimated glomerular filtration rate less than 90 mL/min/1.73 m2 and night-day ratio of mean ambulatory blood pressure (ABP) greater than 0.9, but with normal daytime ABP (<135/85 mm Hg) to avoid the required therapy intensification.
Intervention
Shifting 1 antihypertensive drug from morning to evening.
Outcomes
Percentage of patients changing the night-day ratio of mean ABP from greater than 0.9 to 0.9 or less 8 weeks after the shift.
Measurements
Office blood pressure/ABP and proteinuria at baseline and after the shift.
Results
There were 55% men with a mean age of 67.4 ± 11.3 years and estimated glomerular filtration rate of 46 ± 12 mL/min/1.73 m2. They were treated with 2.4 ± 1.4 antihypertensive drugs. After the drug shift, the night-day ratio of mean ABP decreased in 93.7% of patients, with normal circadian rhythm restored in 87.5%. The nocturnal systolic and diastolic ABP decrease was not associated with an increase in diurnal ABP and was independent from number and class of shifted drug. Office blood pressure in the morning also decreased (from 136 ± 16/77 ± 10 to 131 ± 13/75 ± 8 mm Hg; P = 0.02). Urinary protein excretion decreased from 235 ± 259 to 167 ± 206 mg/d (P < 0.001).
Limitations
Absence of a control group and patients with severe proteinuria or uncontrolled daytime ABP.
Conclusions
In nondipper patients with CKD, changing the timing of antihypertensive therapy decreases nocturnal blood pressure and proteinuria.
ABSTRACT