Effect Analysis Of Adjusting Time Of Antihypertensive Drugs On Masked Uncontrolled Hypertension

Objective:To investigate the impact of modification of the timing of drug dosing on the antihypertensive effect and the control rate of blood pressure in patients with masked uncontrolled hypertension,to analyze the clinical value of chronotherapy.Methods:A total of 337 patients,who admitted to the outpatient or inpatient of cardiology clinic of The first affiliated hospital of fujian medical university and shishi hospital from September 2019 to February 2021 were included,whose blood pressure is normal(OBP < 140/90 mm Hg)and suffer from recurrent dizziness,headache,and/or hypertensive target organ damage.Patients with masked uncontrolled hypertension.(MUCH)were identified by ambulatory blood pressure monitoring(ABPM).Finally,42 patients(mean age 50.62±16.82 years,50% female)with masked uncontrolled hypertension were enrolled.Routine blood test,biochemical examination and ECG examination were obtained.The complications were evaluated by color Doppler echocardiography and carotid ultrasound,and urinary albumin-creatinine ratio examination.The medication time of one drug(ACEI/ARB)in the original antihypertensive regimen was adjusted at night while the type,dosage and medication time of other drugs were kept the same.After 8 weeks of follow-up,ABPM and / or HBPM were conducted to evaluate the efficacy of the new medication regimen.The ABPM data before and after the adjustment of medication time were compared.Paired t-test was used to compare blood pressure before and after adjusting medication time.Results:1.Despite normal blood pressure in the clinic office,the detection rate of patients with masked uncontrolled hypertension was 12.46% in patients with recurrent dizziness and/or hypertensive target organ damage.Among them,28.57% had high blood pressure at night,7.14% had high blood pressure during the day,and64.29% had high blood pressure throughout the day.2.Most patients with masked uncontrolled hypertension were combined with abnormal metabolic indicators: high blood cholesterol(45%),elevated low density lipoprotein cholesterol(7.1%),elevated fasting blood glucose(26%),and hyperuricemia(40%).69% of patients with hypertensive target organ damage were found,69% of patients with combined antihypertensive drug therapy.3.After 8 weeks treatments,the mean values of ABPM and HBP were significantly decreased in the masked uncontrolled hypertension patients(P<0.001).4.Basing on HBPM,the effective rate of blood pressure reduction was 97.62% and control rate was 85.71%.Basing on ABPM,the effective rate of mean blood pressure reduction at 24 hours was 90.48%,and control rate was 59.52%.The effective rate of mean blood pressure reduction at day time was 92.86%,and control rate was 71.43%.The effective rate of nocturnal blood pressure reduction after treatment was 97.62%,and control rate was 54.76%.Conclusions:1.ABPM is helpful to detect patients with masked uncontrolled hypertension.2.Adjust one drug(ACEI/ARB)in the original antihypertensive regimen at night according to the ABPM,blood pressure were significantly improved in patients with MUCH.3.Adjusting the antihypertensive regimen according to chronotherapy has curative effect and has application value in clinical practice.