A Trial of 2 Strategies to Reduce Nocturnal Blood Pressure in Blacks With Chronic Kidney Disease

• Type of Material: Article
• Authors: Mahboob Rahman, Case Western Reserve University; Tom Greene, University of Utah; Robert A Phillips, University of Massachusetts; Lawrence Y Agodoa, National Institute of Diabetes, Digestive and Kidney Diseases; George L Bakris, University of Chicago; Jeanne Charleston, Johns Hopkins University; Gabriel Contreras, University of Miami; Francis Gabbai, University of California, San Diego; Leena Hiremath, Ohio State University; Kenneth Jamerson, University of Michigan; Cynthia Kendrick, Cleveland Clinic Foundation; John W Kusek, National Institute of Diabetes, Digestive and Kidney Diseases; James P Lash, University of Illinois; Janice Lea, Emory University; Edgar R Miller, lll, Johns Hopkins University; Stephen Rostand, University of Alabama; Robert Toto, University of Texas Southwestern Medical Center; Xulei Wang, Cleveland Clinic Foundation; Jackson T Wright, Jr, Case Western Reserve University; Lawrence J Appel, Johns Hopkins University
• Language: English
• Date: 2013-01-01
• Publisher: American Heart Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/HYPERTENSIONAHA.112.200477
• Title of Journal or Parent Work: Hypertension
• ISSN: 0194-911X
• Volume: 61
• Issue: 1
• Start Page: 82
• End Page: +
• Grant/Funding Information: This study was supported by the National Institute of Diabetes, Digestive and Kidney Disease (NIDDK); and an unrestricted grant from King Pharmaceuticals.
• Keywords: DIPPING STATUS; BEDTIME; CARDIOVASCULAR RISK; PREVALENCE; PROGRESSION; DOXAZOSIN; Cardiovascular System & Cardiology; HYPERTENSION; Science & Technology; chronic kidney disease; Peripheral Vascular Disease; TIME; THERAPY; nocturnal blood pressure; HEART-RATE; Life Sciences & Biomedicine; hypertension
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

The objective of our study was to determine the effects of 2 antihypertensive drug dose schedules (PM dose and add-on dose) on nocturnal blood pressure (BP) in comparison with usual therapy (AM dose) in blacks with hypertensive chronic kidney disease and controlled office BP. In a 3-period, crossover trial, former participants of the African American Study of Kidney Disease were assigned to receive the following 3 regimens, each lasting 6 weeks, presented in random order: AM dose (once-daily antihypertensive medications taken in the morning), PM dose (once-daily antihypertensives taken at bedtime), and add-on dose (once-daily antihypertensives taken in the morning and an additional antihypertensive medication before bedtime [diltiazem 60-120 mg, hydralazine 25 mg, or additional ramipril 5 mg]). Ambulatory BP monitoring was performed at the end of each period. The primary outcome was nocturnal systolic BP. Mean age of the study population (n=147) was 65.4 years, 64% were men, and mean estimated glomerular filtration rate was 44.9 mL/min per 1.73 m. At the end of each period, mean (SE) nocturnal systolic BP was 125.6 (1.2) mm Hg in the AM dose, 123.9 (1.2) mm Hg in the PM dose, and 123.5 (1.2) mm Hg in the add-on dose. None of the pairwise differences in nocturnal, 24-hour, and daytime systolic BP was statistically significant. Among blacks with hypertensive chronic kidney disease, neither PM (bedtime) dosing of once-daily antihypertensive nor the addition of drugs taken at bedtime significantly reduced nocturnal BP compared with morning dosing of antihypertensive medications.