Nephrology Service, Departament de Medicina, Corporació Parc Taulí, Institut Universitari Parc Taulí, UAB, Barcelona, Spain.
Nephrol Dial Transplant. 2012 May;27(5):1855-9. doi: 10.1093/ndt/gfr557. Epub 2011 Sep 21.
Refractory arterial hypertension (RAH) is frequently associated to a non-dipping blood pressure (BP) pattern; this profile has been shown to have a worse clinical prognosis. It is a common clinical practice that patients receive anti-hypertensive medication preferentially in the morning. Non-dipping could be related to the timing of anti-hypertensive drug administration. We analysed whether switching anti-hypertensive medication to bedtime could improve BP control in non-dipper patients with RAH.
Twenty-seven consecutive patients with RAH and non-dipper or riser BP pattern on ambulatory blood pressure (ABP) monitoring were studied before and after 6 weeks of a change in the timing of anti-hypertensive medications. The intervention consisted of shifting all non-diuretic anti-hypertensive drugs from morning to evening, maintaining the same drugs at the same doses. A parallel group of 12 consecutive patients with similar characteristics and no changes in the therapeutic regimen formed the control group.
There were 59% women, mean age 65.7 ± 8.4 years. They were treated with 4 ± 0.7 anti-hypertensive drugs, 90% administered in the morning. At baseline, diurnal and nocturnal ABP averaged 141.6 ± 10.6/81.5 ± 9.3 and 141.7 ± 11/78 ± 8.8, respectively. After the drug shift, mean diurnal and nocturnal ABP was 140.5 ± 10.4/80.5 ± 9.6 and 135.7 ± 12.5/73.8 ± 9.3 (P = 0.005 and 0.04 for systolic and diastolic ABP), 15% of the patients restored a normal ABP circadian rhythm. No changes were observed in the control group.
In non-dipper or riser patients with RAH, changing the timing of anti-hypertensive medication to the evening could improve BP control.
难治性动脉高血压（RAH）常伴有非杓型血压（BP）模式；这种情况已被证明临床预后较差。临床上常优先在早上给患者服用抗高血压药物。非杓型可能与抗高血压药物给药时间有关。我们分析了将抗高血压药物给药时间改为晚上是否可以改善 RAH 中非杓型患者的血压控制。
在接受 6 周的抗高血压药物治疗时间改变后，对 27 例连续的 RAH 患者和动态血压监测（ABP）显示非杓型或升型 BP 模式的患者进行了研究。干预措施包括将所有非利尿剂抗高血压药物从早上改为晚上，保持相同的药物和相同的剂量。一组 12 例具有相似特征且治疗方案无变化的连续患者作为对照组。
女性占 59%，平均年龄 65.7±8.4 岁。他们接受了 4±0.7 种抗高血压药物治疗，90%的药物在早上给药。基线时，日间和夜间 ABP 平均为 141.6±10.6/81.5±9.3 和 141.7±11/78±8.8。药物调整后，日间和夜间平均 ABP 分别为 140.5±10.4/80.5±9.6 和 135.7±12.5/73.8±9.3（收缩压和舒张压 ABP 分别为 P=0.005 和 0.04），15%的患者恢复了正常的 ABP 昼夜节律。对照组没有观察到变化。
在 RAH 中非杓型或升型患者中，将抗高血压药物的给药时间改为晚上可以改善血压控制。
