Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.
Hypertens Res. 2012 Jul;35(7):720-4. doi: 10.1038/hr.2012.25. Epub 2012 Mar 1.
Morning hypertension is an independent risk factor for cardiovascular diseases, particularly stroke. However, the optimal time at which to take antihypertensive medication to treat morning hypertension remains unclear. We prospectively enrolled elderly patients (over 65 years old) with morning hypertension who had suffered an ischemic stroke (or strokes). Additional treatments (one of six arms) were randomly administered for 10 weeks in the morning, in the evening or at bedtime (n=15 for each time point/medication). The patients measured their blood pressure and heart rate at home for 14 days prior to the intervention and for the final 14 days, and recorded the data in a blood pressure diary. The patients' urinary albumin/creatinine ratios were evaluated before and after the 10-week intervention. A total of 270 patients were enrolled in this study (mean age: 75.6±5.8 years; female/male ratio: 125/145). Their morning and evening systolic blood pressures were significantly decreased after following any of the study medication dosing schedules (P<0.001). However, the reductions in the differences between the morning and evening systolic blood pressures were significant only when the medication was taken in the evening or at bedtime (P<0.001 with repeated measures analysis of variance). Furthermore, the recovery rate from morning hypertension was also higher when the medication was taken in the evening (40.0%) or at bedtime (45.6%), rather than in the morning (22.2%; P=0.003 with the χ(2)-test). Antihypertensive medication taken in the evening or at bedtime is the most effective in treating morning hypertension when the patient adheres to the medication regimen.
晨峰高血压是心血管疾病（尤其是中风）的一个独立危险因素。然而，治疗晨峰高血压的最佳降压药物服用时间仍不清楚。我们前瞻性地招募了患有晨峰高血压并曾发生过缺血性中风（或中风）的老年患者（年龄超过 65 岁）。在早上、晚上或睡前（每个时间点/药物治疗组各 15 例）随机给予额外的治疗（六种治疗方案中的一种）10 周。患者在干预前 14 天和最后 14 天在家中测量血压和心率，并在血压日记中记录数据。在 10 周干预前后评估患者的尿白蛋白/肌酐比值。共有 270 例患者入组本研究（平均年龄：75.6±5.8 岁；女性/男性比例：125/145）。在服用任何研究药物方案后，患者的清晨和傍晚收缩压均显著降低（P<0.001）。然而，只有当药物在晚上或睡前服用时，清晨和傍晚收缩压之间的差值才会显著降低（重复测量方差分析，P<0.001）。此外，当药物在晚上（40.0%）或睡前（45.6%）服用时，从晨峰高血压的恢复率也更高，而不是在早上（22.2%；卡方检验，P=0.003）。当患者坚持药物治疗方案时，晚上或睡前服用降压药对治疗晨峰高血压最有效。
