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Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial.
Am J Kidney Dis. 2007 Dec; 50(6):908-17.AJ

Abstract

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 m(2) 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 m(2). 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.

Authors+Show Affiliations

Minutolo R
Department of Nephrology, Second University of Naples, Naples, Italy. roberto.minutolo@unina2.it
Gabbai FB
No affiliation info available
Borrelli S
No affiliation info available
Scigliano R
No affiliation info available
Trucillo P
No affiliation info available
Baldanza D
No affiliation info available
Laurino S
No affiliation info available
Mascia S
No affiliation info available
Conte G
No affiliation info available
De Nicola L
No affiliation info available

MeSH

Administration, OralAdrenergic beta-AntagonistsAgedAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsBlood PressureBlood Pressure Monitoring, AmbulatoryCalcium Channel BlockersCardiovascular DiseasesChronic DiseaseCircadian RhythmDrug Administration ScheduleDrug Therapy, CombinationFemaleGlomerular Filtration RateHumansHypertensionKidney DiseasesMaleMiddle AgedPilot ProjectsProteinuria

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

18037091

Clinical Trial Links

Post Kidney Transplant Nocturnal Hypertension Prevalence and Management Study
Chronotherapy Versus Conventional BP Control to Correct Abnormal Circadian BP Pattern in Kidney Transplant Recipients

Citation

Minutolo, Roberto, et al. "Changing the Timing of Antihypertensive Therapy to Reduce Nocturnal Blood Pressure in CKD: an 8-week Uncontrolled Trial." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 50, no. 6, 2007, pp. 908-17.
Minutolo R, Gabbai FB, Borrelli S, et al. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. Am J Kidney Dis. 2007;50(6):908-17.
Minutolo, R., Gabbai, F. B., Borrelli, S., Scigliano, R., Trucillo, P., Baldanza, D., Laurino, S., Mascia, S., Conte, G., & De Nicola, L. (2007). Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 50(6), 908-17.
Minutolo R, et al. Changing the Timing of Antihypertensive Therapy to Reduce Nocturnal Blood Pressure in CKD: an 8-week Uncontrolled Trial. Am J Kidney Dis. 2007;50(6):908-17. PubMed PMID: 18037091.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. AU - Minutolo,Roberto, AU - Gabbai,Francis B, AU - Borrelli,Silvio, AU - Scigliano,Raffaele, AU - Trucillo,Paolo, AU - Baldanza,Diego, AU - Laurino,Simona, AU - Mascia,Sara, AU - Conte,Giuseppe, AU - De Nicola,Luca, PY - 2007/05/09/received PY - 2007/07/18/accepted PY - 2007/11/27/pubmed PY - 2007/12/12/medline PY - 2007/11/27/entrez SP - 908 EP - 17 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 50 IS - 6 N2 - 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 m(2) 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 m(2). 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18037091/Changing_the_timing_of_antihypertensive_therapy_to_reduce_nocturnal_blood_pressure_in_CKD:_an_8_week_uncontrolled_trial_ DB - PRIME DP - Unbound Medicine ER -