Hypertension research : official journal of the Japanese Society of Hypertension
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Randomized Controlled Trial
Risk of incident chronic kidney disease is better reduced by bedtime than upon-awakening ingestion of hypertension medications.
This trial investigated whether therapy with the entire daily dose of ≥1 hypertension medications at bedtime exerts a greater reduction in the risk of incident chronic kidney disease (CKD) than therapy with all medications upon awakening. We conducted a prospective, open-label, blinded endpoint trial of 2078 hypertensive patients without CKD (1017 men/1061 women, 53.6 ± 13.7 years of age) randomized to ingest all their prescribed hypertension medications upon awakening (n = 1041) or the entire daily dose of ≥1 of those medications at bedtime (n = 1037). ⋯ Greater benefit was observed for bedtime than awakening treatment, with angiotensin converting enzyme inhibitors and angiotensin receptor blockers. In hypertensive patients without CKD, ingestion of ≥1 BP-lowering medications at bedtime, mainly those modulating or blocking the effects of angiotensin II, compared with ingestion of all such medications upon-awakening, resulted in improved ambulatory BP control (significant further decrease of asleep BP and enhanced sleep-time relative BP decline) and reduced risk of incident CKD.