Recently, great attention has been focused on chronotherapy and bedtime administration for uncontrolled hypertension. The present study aimed to determine which type of chronotropic administration is better for ARB-based combination therapies.Design and Method:
We conducted a prospective, cross-over trial in hypertensive outpatients not achieving target blood pressures. Ten participants (61 ± 15 years) were assigned to switch treatment to a morning ARB (olmesartan 20 mg)+bedtime CCB (azelnidipne 16 mg) (group AC), morning CCB+bedtime ARB (group CA), or morning fixed dose combination of an ARB+CCB (group FD). We measured the average BP (ABP), daytime BP (DBP) and nighttime BP (NBP) with ambulatory BP monitoring (ABPM) of the three groups, and compared those values with each home blood pressure (HBP) measurement. We also measured the heart rate (HR), central blood pressure (CBP), and augmentation index (AI). We further measured the changes in the BP, albuminuria, and laboratory values.Results:
There were no significant differences among the groups regarding each of the BP parameters, HR, CBP, and AI. However, there was a decreasing tendency of the average BP and nighttime BP in group AC, and decreasing tendency of the CBP and AI in group FD. Regarding the coeffcient variant of the SBP in the ABPM, group AC had the lowest value of the three groups. There was no significant difference regarding the urine albumin/creatine ratio.Conclusions:
The morning ARB+bedtime CCB administration was effective in controlling the nighttime to morning BP control, whereas a morning fixed dose combination of an ARB+CCB was effective in controlling the CBP and AI. The application of chronotherapy with ARB and CCB combinations would be useful for a better BP control.