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). During a 5.9-year median follow-up, 368 participants developed CKD. Patients of the bedtime, compared with the morning, treatment group showed (i) significantly lower asleep blood pressure (BP) mean, greater sleep-time relative BP decline, and attenuated prevalence of non-dipping at the final evaluation (38 vs. 55%; P < 0.001); and (ii) a significantly lower hazard ratio of CKD, adjusted for the significant influential characteristics of age, serum creatinine, urinary albumin, type 2 diabetes, previous cardiovascular event, asleep systolic BP mean, and sleep-time relative systolic BP decline (0.27 (95% confidence interval: 0.21-0.36); event-rate 8.3 vs. 27.1% in the bedtime and ...Continue Reading
Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes
Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy
Progression of renal insufficiency in type 2 diabetes with and without microalbuminuria: results of the Heart Outcomes and Prevention Evaluation (HOPE) randomized study
Decrease in urinary albumin excretion associated with the normalization of nocturnal blood pressure in hypertensive subjects
Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement
Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease
Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension
Effect of dosing time of angiotensin II receptor blockade titrated by self-measured blood pressure recordings on cardiorenal protection in hypertensives: the Japan Morning Surge-Target Organ Protection (J-TOP) study
The bedtime administration ameliorates blood pressure variability and reduces urinary albumin excretion in amlodipine-olmesartan combination therapy
Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study
Prognostic role of ambulatory blood pressure measurement in patients with nondialysis chronic kidney disease
Decreasing sleep-time blood pressure determined by ambulatory monitoring reduces cardiovascular risk
Non-dipper status and left ventricular hypertrophy as predictors of incident chronic kidney disease.
A bedtime dose of ARB was better than a morning dose in improving baroreflex sensitivity and urinary albumin excretion--the J-TOP study
Administration-time differences in effects of hypertension medications on ambulatory blood pressure regulation
Ambulatory blood pressure monitoring: importance of sampling rate and duration--48 versus 24 hours--on the accurate assessment of cardiovascular risk
Clinical application of a novel automatic algorithm for actigraphy-based activity and rest period identification to accurately determine awake and asleep ambulatory blood pressure parameters and cardiovascular risk
Nebivolol treatment improves resistant arterial function and reduces ventricular hypertrophy and angiotensin II in spontaneously hypertension rats
2013 ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals
2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Night-time blood pressure is associated with the development of chronic kidney disease in a general population: the Ohasama Study
Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension
Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force
Prospective analysis of the association of ambulatory blood pressure characteristics with incident chronic kidney disease
Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial
Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks
Sleep-time ambulatory blood pressure as a prognostic marker of vascular and other risks and therapeutic target for prevention by hypertension chronotherapy: Rationale and design of the Hygia Project
Obesity, Renin-Angiotensin System Blockade and Risk of Adverse Renal Outcomes: A Population-Based Cohort Study
Hypertension: New perspective on its definition and clinical management by bedtime therapy substantially reduces cardiovascular disease risk
The Hygia Project and Hygia Chronotherapy Trial: insights of we clinical investigators on the impact of the embedded continuing medical education on primary-care practice and improved patient cardiovascular health.
Bedtime hypertension chronotherapy best reduces cardiovascular disease risk as corroborated by the Hygia Chronotherapy Trial. Rebuttal to European Society of Hypertension officials.
Bedtime hypertension chronotherapy best reduces cardiovascular disease risk as documented by MAPEC and Hygia Chronotherapy outcomes trials.
Chronotherapy for hypertension: improvement in patient outcomes with bedtime administration of antihypertensive drugs.
Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti-hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial.
Chronotherapy for morning blood pressure surge in hypertensive patients: a systematic review and meta-analysis.
Chronotherapy of cardiac and vascular disease: timing medications to circadian rhythms to optimize treatment effects and outcomes.
Clinical Trials Mentioned
Antihypertensive Agents: Mechanisms of Action
Antihypertensive drugs are used to treat hypertension (high blood pressure) which aims to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Discover the latest research on antihypertensive drugs and their mechanism of action here.
CV Disorders & Type 2 Diabetes
This feed focuses on the association of cardiovascular diseases in patients with type 2 diabetes.