Chronotherapy for hypertension in patients with chronic kidney disease: a systematic review and meta-analysis in non-black patients.

Abstract

To investigate the effects of chronotherapy on blood pressure in patients with chronic kidney disease (CKD). We searched PUBMED, EMBASE, ASN-ONLINE, the Cochrane Library and the reference articles of published papers without language restriction, for randomized and non-randomized trials that assessed the effect of chronotherapy versus morning dosing regimen drug therapy for CKD patients with hypertension. Meta-analysis was done with random-effect models. After application of inclusion/exclusion criteria, three randomized controlled trials including 3380 patients were analyzed. Compared with morning dosing regimen drug therapy, chronotherapy was associated with a significant decrease of 3.55% in sleep-time relative decline of systolic blood pressure (SBP) (mean difference [MD], 95% CI, [0.22, 6.88]). In the chronotherapy group, we noted a significant decrease in nocturnal SBP (MD -3.79mmHg, 95% CI, [-7.18, -0.41]) and nocturnal diastolic blood pressure (MD -1.55mmHg, 95% CI. [-2.28, -0.82]), but there was a small increase in awake SBP by 1.19mmHg (MD, 95% CI, [0.06, 2.31]). No significant difference was noted in all-cause mortality and cardiovascular mortality. This meta-analysis suggests that chronotherapy could reduce nocturnal BP in hypertensive CKD patients.