title: A trial of 2 strategies to reduce nocturnal blood pressure in blacks with chronic kidney disease.
abstract: The objective of our study was to determine the effects of 2 antihypertensive drug dose schedules (PM dose and add-on dose) on nocturnal blood pressure (BP) in comparison with usual therapy (AM dose) in blacks with hypertensive chronic kidney disease and controlled office BP. In a 3-period, crossover trial, former participants of the African American Study of Kidney Disease were assigned to receive the following 3 regimens, each lasting 6 weeks, presented in random order: AM dose (once-daily antihypertensive medications taken in the morning), PM dose (once-daily antihypertensives taken at bedtime), and add-on dose (once-daily antihypertensives taken in the morning and an additional antihypertensive medication before bedtime [diltiazem 60-120 mg, hydralazine 25 mg, or additional ramipril 5 mg]). Ambulatory BP monitoring was performed at the end of each period. The primary outcome was nocturnal systolic BP. Mean age of the study population (n=147) was 65.4 years, 64% were men, and mean estimated glomerular filtration rate was 44.9 mL/min per 1.73 m(2). At the end of each period, mean (SE) nocturnal systolic BP was 125.6 (1.2) mm Hg in the AM dose, 123.9 (1.2) mm Hg in the PM dose, and 123.5 (1.2) mm Hg in the add-on dose. None of the pairwise differences in nocturnal, 24-hour, and daytime systolic BP was statistically significant. Among blacks with hypertensive chronic kidney disease, neither PM (bedtime) dosing of once-daily antihypertensive nor the addition of drugs taken at bedtime significantly reduced nocturnal BP compared with morning dosing of antihypertensive medications.
authors.affiliation: Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. Mahboob.Rahman@uhhospitals.org
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Robert A
authors.initials: RA
authors.lastname: Phillips
authors.forename: Lawrence Y
authors.initials: LY
authors.lastname: Agodoa
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Gabriel
authors.initials: G
authors.lastname: Contreras
authors.forename: Francis
authors.initials: F
authors.lastname: Gabbai
authors.forename: Leena
authors.initials: L
authors.lastname: Hiremath
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jamerson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kendrick
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
authors.forename: Janice
authors.initials: J
authors.lastname: Lea
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Miller
authors.forename: Stephen
authors.initials: S
authors.lastname: Rostand
authors.forename: Robert
authors.initials: R
authors.lastname: Toto
authors.forename: Xulei
authors.initials: X
authors.lastname: Wang
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D018592:Cross-Over Studies; D004110:Diltiazem / Q000008:administration & dosage* / Q000494:pharmacology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006830:Hydralazine / Q000008:administration & dosage* / Q000494:pharmacology; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000008:administration & dosage* / Q000494:pharmacology; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D006830:Hydralazine; D004110:Diltiazem; D017257:Ramipril