UH2 Project: Blood Pressure Medication Timing Study (BPMedTime)
Principal Investigator: Gary Rosenthal, MD
Sponsoring Institution: University of Iowa
Collaborator: Duke University Health System
NIH Institute Providing Oversight: The National Center for Complementary and Integrative Health (NCCIH)
Program Official: Wendy Weber (NCCIH)
Project Scientist: Catherine Meyers (NCCIH)
NIH Project Number: 1UH2AT007784
Blood pressure exhibits circadian variability, decreasing during sleep (“nighttime dipping”) and increasing quickly upon arising. In the last 20 years, the development and increasing use of longer acting antihypertensive medications has led to improved patient compliance. However, many once-daily antihypertensives require 60 to 90 minutes to achieve peak plasma concentrations after ingestion and do not maintain sustained plasma concentrations for a full 24 hours. Thus, when taken in the morning, medication concentrations may not be high enough to fully protect against the morning surge in blood pressure that occurs in most patients.
The goal of the BPMedTime randomized pragmatic trial is to evaluate the risk of adverse cardiovascular events in patients who are instructed to take their currently prescribed once-daily antihypertensive medications at bedtime compared with patients who continue to take their once-daily antihypertensive medications in the morning or afternoon. The rationale for the trial is that nighttime dosing may better control the early morning rise in blood pressure that occurs in most patients and that is associated with an increased risk of acute cardiovascular events. Nighttime dosing may also promote greater nighttime dipping of blood pressure in patients with hypertension and other chronic illnesses, such as chronic kidney disease and diabetes. Such nighttime dipping has been shown to be protective of cardiovascular events.