Antihypertensive agent at bedtime in patients with resistant hypertension

Abstract

Resistant hypertensions has a high prevalence in hypertensive patients who remain blood pressure above goal in spite of the concurrent use of 3 antihypertensive agents of different classes. Patients with resistant hypertension are at the greater risk of cardiovascular events, especially, non-dipperpattern. Concordantly, accumulating evidences showed that taking at least one antihypertensive agent at bedtime in patients with resistant hypertension diminished bedtime blood pressure; The prevalence ofnon-dipper and risk of cardiovascular events are better than taking all medications on awakening. However, clinical application of chronotherapy should be carefully considered for various factors including types ofantihypertensive drugs, patients with comorbidities, adherence and individual variation. Further investigation, especially large randomized controlled trials, is needed to evaluate the definitive impact of dosing antihypertensives at bedtime in resistant hypertension.