Sleep-time blood pressure as a therapeutic target for reducing the risk of developing chronic kidney disease

Abstract

53.6 13.7 years of age. Patients were randomized to ingest all their prescribed hypertension medications upon awakening or the entire daily dose of 1 of them at bedtime. At baseline and annually (or more frequently if hypertension treatment was adjusted based on ambulatory BP) thereafter, BP and physical activity (wrist actigraphy) were simultaneously monitored for 48h to accurately derive the awake and asleep BP means. During a 5.9-year median follow-up, 368 patients developed CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2, albuminuria, or both, at least twice within 3 months). The Kaplan-Meier survival curves indicated a highly significant difference between treatment-time groups in event-free survival (log-rank 119.7, P<0.001). Participants ingesting 1 BP-lowering medications at bedtime showed a significantly lower hazard ratio (HR) of new-onset CKD (adjusted by the significant influential characteristics of age, waist perimeter, diabetes, sleep-time systolic BP mean, and sleep-time relative systolic BP decline) than those ingesting all medications upon awakening (0.28 [95%CI: 0.22-0.36]; event-rate 8.3 vs. 27.1%; P<0.001). There was an even further benefit in preventing CKD among patients ingesting not just one but all BP-lowering medications at bedtime (event-rate 3.8 vs. 13.5% in patients ingesting medications both upon awakening and at bedtime; P<0.001). In hypertensive patients without CKD, ingestion of at least one, preferably all, BP-lowering medication at bedtime, compared to ingestion of all medications upon-awakening, resulted in improved ambulatory BP control (significant further reduction of asleep BP and enhanced sleep-time relative BP decline) and markedly reduced prevalence of new-onset CKD.