According to the current study by Hermida and colleagues, taking antihypertensive medications at bedtime rather than in the morning has been shown to be associated with an increase in bedtime blood pressure (BP) decline toward a dipping pattern and better BP control and reduction in urinary protein excretion. Nocturnal hypertension is more common among patients with chronic kidney disease (CKD) who may thus experience greater effects of time medications for hypertension.

This randomized controlled, open-label trial compares the effect of bedtime vs morning administration of BP medications on a composite of cardiovascular disease (CVD) outcomes and BP control.

According to Dr. Hermida and colleagues, “treatment at bedtime is the most cost-effective and simplest strategy of successfully achieving the therapeutic goals of adequate asleep BP reduction and preserving or re-establishing the normal 24-hour BP dipping pattern.”

The authors suggest that a potential explanation for the benefit of nighttime treatment may be associated with the effect of nighttime treatment on urinary albumin excretion levels. “We previously demonstrated that urinary albumin excretion was significantly reduced after bedtime, but not morning, treatment with valsartan,” they note. In addition, this reduction was independent of 24-hour changes of BP, but correlated with a decline in BP during sleep.

Refer: J Am Soc Nephrol. Published online October 24, 2011