JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China.
Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur.
J Hypertens. 2024 Oct 1;42(10):1653-1664. doi: 10.1097/HJH.0000000000003783. Epub 2024 Jun 14.
Since the effects of once-daily antihypertensive (HT) medications are more pronounced within the first few hours of ingestion, evening administration of anti-HT medications can be a feasible treatment for nocturnal HT. However, no relevant meta-analysis has been conducted in patients with nocturnal HT. This meta-analysis included randomized controlled trials involving patients with elevated mean nocturnal blood pressure (BP) and compared evening anti-HT administration with morning administration. Multiple databases, including grey literature (e.g. clincialtrial.gov), were searched. Study selection and data extraction were conducted by two independent authors. Risk of bias assessment and overall quality of evidence were conducted using Cochrane risk-of-bias tool and GRADE by two independent authors. A total of 107 studies were included, 76 of which were investigated in China and had not been identified in previous reviews. Only one trial was ranked low risk-of-bias. Evening administration of anti-HT medications was effective in reducing nocturnal systolic BP (4.12-9.10 mmHg; I2 = 80.5-95.2%) and diastolic BP (3.38-5.87 mmHg; I2 = 87.4-95.6%). Subgroup analyses found that the effectiveness of evening administration was contributed by data from the Hermida group and China. Evening administration did not provide additional nocturnal/daytime/24-h BP reduction in non-Hermida/non-China studies (I2 = 0) and in meta-analyses that included studies with unclear or low risk of bias. The effectiveness of nocturnal BP reduction was similar across different types, doses, and half-lives of medications. Evening administration of anti-HT medications may reduce proteinuria, left ventricular hypertrophy (LVH), nondipping and morning surge. The overall quality of evidence was ranked as very low to low. Our results highlight the scarcity of low risk-of-bias studies and emphasize the need for such trials to evaluate the efficacy of evening dosing of anti-HT medications as a standard treatment for patients with nocturnal HT across diverse populations.
由于每日一次的降压（HT）药物的作用在摄入后的头几个小时内更为明显，因此晚间给予抗-HT 药物可能是治疗夜间 HT 的一种可行方法。然而，对于夜间 HT 患者，尚未进行相关的荟萃分析。本荟萃分析纳入了涉及夜间平均血压升高的患者的随机对照试验，并比较了晚间给予抗-HT 药物与晨间给药。我们检索了多个数据库，包括灰色文献（例如 clincialtrial.gov）。两位作者独立进行了研究选择和数据提取。两位作者使用 Cochrane 偏倚风险工具和 GRADE 对偏倚风险评估和总体证据质量进行了评估。共纳入了 107 项研究，其中 76 项在中国进行，之前的综述中未发现。只有一项试验被评为低偏倚风险。晚间给予抗-HT 药物可有效降低夜间收缩压（4.12-9.10 mmHg；I2=80.5-95.2%）和舒张压（3.38-5.87 mmHg；I2=87.4-95.6%）。亚组分析发现，晚间给药的有效性归因于 Hermida 组和中国的数据。在非 Hermida/非中国研究（I2=0）和包括偏倚风险不明确或低的研究的荟萃分析中，晚间给药并未提供额外的夜间/日间/24 小时血压降低。夜间血压降低的效果在不同类型、剂量和半衰期的药物中相似。晚间给予抗-HT 药物可能会减少蛋白尿、左心室肥厚（LVH）、非杓型和晨峰。总体证据质量评为极低至低。我们的结果突出了低偏倚风险研究的稀缺性，并强调需要进行此类试验来评估夜间给药抗-HT 药物作为治疗各种人群夜间 HT 的标准治疗方法的疗效。
