| BackgroundsHypertension is a global public health issue.As the WHO data shows,globally cardiovascular disease accounts for approximately 17 million deaths a year,nearly one third of the total.Of these,complications of hypertension account for 9.4 million deaths worldwide every year.Hypertension is responsible for at least 45%of deaths due to heart disease and 51%of deaths due to stroke?In the recent hypertension guidelines,the criteria for hypertension in different measurement methods and the drags recommended for treating hypertension with different clinical conditions have been clear,but uncontrolled hypertension which may lead to serious cardiovascular events,increasing dosage and life threatening consequences is present in most patients treated with only a single morning dose or fixed dose drug combination,so the monitoring and management of high blood pressure is very important.The mean nocturnal BP value has been suggested as the most sensitive predictor of cardio-and cerebrovascular morbidity and mortality,in other words,insufficient BP fall at night compared to daytime level or a non-dipping pattern is associated with elevated risk of end-organ injury,particularly to the heart(left ventricular hypertrophy,congestive heart failure and myocardial infarct),brain(stroke)and kidney(albuminuria and progression to end-stage renal failure)and poor prognosis.ObjectiveBedtime administration of antihypertensive drugs is receiving more attentions,but no clear consensus has been reached on the BP-lowering effect of this strategy-Recent researches have documented that ingesting at least one antihypertensive medication at bedtime,compared with treatment with all medications upon awakening,showed a significant reduction in the 24-h mean SBP/DBP and the reduction was much more prominent during nighttime,decreasing the prevalence of non-dipping,however,the similar 24-h mean SBP/DBP reduction for both treatment times were also have been reported.Therefore,we conduct this meta-analysis to investigate the effects of bedtime administration of blood-pressure lowering agents on ambulatory blood pressure monitoring results.MethodsWe systematically searched literature for clinical trials of time of ingestion of antihypertensive drugs evaluated by ambulatory blood pressure monitoring(ABPM)to do a meta-analysis which aimed to determine the difference in diurnal,nocturnal and 24-h mean of SBP and DBP,absolute BP reduction from baseline between bedtime administration group(experimental group)and morning(awaking)administration group(control group).ResultsThe synthesis analysis showed that the level of BP in bedtime administration group was lower than the morning administration group,which reduced diurnal SBP/DBP by 1.67/1.13mmHg(P=0.36/0.48),24-h SBP/DBP by 2.78/0.36 mmHg(P=0.09/0.62),nocturnal SBP/DBP by 6.32/3.17mmHg(P=0.03/0.007).Furthermore,there was lack of statistically significant differences in the diurnal mean of SBP/DBP reduction from baseline between the two groups(P=0.94/0.85),but bedtime administration resulted in significant reduction from baseline in the nocturnal mean of SBP/DBP,by-4.72/-3.57mmHg(P=0.01/0.05).Funnel plot demonstrated that there was no evidence of publication bias.ConclusionsAdministration of ?1 antihypertensive drugs at bedtime or evening results in a greater reduction of nocturnal hypertension than dosing upon morning without loss the efficacy of diurnal and 24h mean BP reduction. |
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