title: The optimal timing of antihypertensive medication administration for morning hypertension in patients with cerebral infarction.
abstract: 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.
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan. nhosomi@hiroshima-u.ac.jp
authors.forename: Naohisa
authors.initials: N
authors.lastname: Hosomi
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Sueda
authors.forename: Hisashi
authors.initials: H
authors.lastname: Masugata
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Dobashi
authors.forename: Koji
authors.initials: K
authors.lastname: Murao
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Takanori
authors.initials: T
authors.lastname: Miki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kohno
authors.forename: Akira
authors.initials: A
authors.lastname: Nishiyama
authors.forename: Masayasu
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000188:drug therapy; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D018660:Blood Pressure Monitoring, Ambulatory; D002544:Cerebral Infarction / Q000188:drug therapy*; D002940:Circadian Rhythm / Q000502:physiology; D003404:Creatinine / Q000652:urine; D004334:Drug Administration Schedule; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine