Wang Caixia, Ye Yuqiu, Liu Chunyong, Zhou Yongming, Lv Linsheng, Cheng Cailian, Li Shaomin, Lou Tanqi, Liu Xun
Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Nephrology, The Second People's Hospital of Shanxi Province, Shanxi, China.
Intern Med J. 2017 Aug;47(8):900-906. doi: 10.1111/imj.13490.
Evening dosing regimen drug therapy on blood pressure (BP) control is used widely, but its clinical benefits and preservation or re-establishment of the normal 24-h BP dipping pattern in chronic kidney disease (CKD) patients is not known.
To investigate the effect of an evening dosing regimen of antihypertensive drugs on BP patterns of CKD patients with hypertension.
A systematic review was conducted by searching PUBMED, EMBASE, ASN-ONLINE, the Cochrane Library and the reference lists of relevant articles of published papers. All trials designed to evaluate the effects of evening versus morning dosing regimen drug therapy for CKD patients with hypertension were included. Meta-analysis was performed using random or fixed effects models.
Five randomised controlled trials and one comparative study, including 3732 patients, met the inclusion criteria. Compared with morning dosing regimen drug therapy, evening administration of antihypertensive medication was associated with a significant reduction of 40% in non-dipper BP patterns (risk ratio (RR), 95% CI, (0.43, 0.84)). We noted a significant decrease in nocturnal systolic blood pressure (SBP) (MD -3.17 mmHg, 95% CI (-5.41, -0.94)), a significant reduction in nocturnal diastolic blood pressure (DBP) (MD -1.37 mmHg, 95% CI (-2.05, -0.69)) and a significant increase in awake SBP (MD 1.15 mmHg, 95% CI (0.10, 2.19)) in patients assigned to the evening dosing regimen drug therapy group. Patients showed no significant differences for all-cause mortality and cardiovascular mortality.
This review shows that evening dosing regimen drug therapy could reverse non-dipper BP patterns in hypertensive CKD patients.
晚间给药方案的药物治疗在血压（BP）控制方面被广泛应用，但其对慢性肾脏病（CKD）患者的临床益处以及正常24小时血压勺型模式的维持或重新建立情况尚不清楚。
研究抗高血压药物晚间给药方案对CKD高血压患者血压模式的影响。
通过检索PUBMED、EMBASE、ASN-ONLINE、Cochrane图书馆以及已发表论文的相关文章参考文献列表进行系统评价。纳入所有旨在评估晚间与晨间给药方案药物治疗对CKD高血压患者影响的试验。采用随机或固定效应模型进行荟萃分析。
五项随机对照试验和一项比较研究，共3732例患者，符合纳入标准。与晨间给药方案药物治疗相比，晚间给予抗高血压药物与非勺型血压模式显著降低40%相关（风险比（RR），95%置信区间（CI），（0.43，0.84））。我们注意到，在接受晚间给药方案药物治疗组的患者中，夜间收缩压（SBP）显著降低（平均差（MD）-3.17 mmHg，95% CI（-5.41，-0.94）），夜间舒张压（DBP）显著降低（MD -1.37 mmHg，95% CI（-2.05，-0.69）），清醒时SBP显著升高（MD 1.15 mmHg，95% CI（0.10，2.19））。患者在全因死亡率和心血管死亡率方面无显著差异。
本综述表明，晚间给药方案药物治疗可逆转CKD高血压患者的非勺型血压模式。
