PERSPECTIVES ON THE CHRONOTHERAPY OF HYPERTENSION BASED ON THE RESULTS OF THE MAPEC STUDY

Figures & data

TABLE 1 Changes from baseline (in mm Hg) in ABPM-determined 48-h, awake, and asleep SBP and DBP means of different hypertension medications when routinely ingested upon awakening (Awakening Rx) or at bedtime (Bedtime Rx) by diurnally active hypertensive subjects

		Effect on 48-h SBP/DBP means		Effect on awake SBP/DBP means		Effect on asleep SBP/DBP means
Medication (dose, Rx duration)	No. of subjects	Awakening Rx	Bedtime Rx	Awakening Rx	Bedtime Rx	Awakening Rx	Bedtime Rx
Doxazosin GITS (4 mg, 12 wks)	39^a	−1.8/ − 3.2	−6.9/ − 5.9^‡	−2.9/ − 3.7	−6.0/ − 5.4	0.7/ − 1.3	−8.2/ − 6.5^†
Doxazosin GITS (4 mg, 12 wks)	52^b	−2.2/ − 1.9	−5.3/ − 4.5	−3.4/ − 2.9	−5.9/ − 4.4	0.1/ − 0.5	−4.9/ − 5.3^‡
Nebivolol (5 mg, 8 wks)	173	−13.0/ − 11.3	−12.8/ − 10.3	−14.7/ − 12.4	−13.4/ − 10.9	−7.9/ − 7.4	−10.2/ − 8.1
Torasemide (5 mg, 6 wks)	113	−6.4/ − 3.4	−14.8/ − 9.5*	−7.3/ − 3.7	−15.6/ − 9.9*	−4.3/ − 2.5	−12.5/ − 8.0*
Ramipril (5 mg, 6 wks)	115	−8.5/ − 6.2	−11.2/ − 9.5^†	−10.1/ − 6.9	−10.5/ − 9.0	−4.5/ − 4.1	−13.5/ − 11.5*
Spirapril (6 mg, 12 wks)	165	−8.7/ − 7.0	−9.8/ − 6.6	−9.9/ − 8.0	−8.5/ − 5.7	−5.7/ − 4.6	−12.8/ − 8.6*
Valsartan (160 mg, 12 wks)	90	−17.0/ − 11.2	−14.6/ − 11.4	−17.0/ − 11.1	−12.0/ − 9.8	−15.9/ − 10.8	−17.9/ − 13.3
Valsartan (160 mg, 12 wks)	100^c	−12.3/ − 6.3	−15.3/ − 9.2^‡	−12.8/ − 6.6	−13.0/ − 8.5	−10.9/ − 5.5	−20.5/ − 11.1*
Valsartan (160 mg, 12 wks)	200^d	−13.0/ − 8.1	−15.2/ − 10.6^‡	−13.1/ − 8.3	−12.6/ − 9.3	−12.9/ − 8.1	−21.1/ − 13.9*
Olmesartan (20 mg, 12 wks)	123	−13.8/ − 11.2	−13.9/ − 10.2	−14.5/ − 12.1	−13.3/ − 9.6	−11.2/ − 8.7	−15.2/ − 11.5^‡
Telmisartan (80 mg, 12 wks)	215	−10.6/ − 7.9	−11.7/ − 8.3	−11.7/ − 8.8	−11.3/ − 8.2	−8.3/ − 6.4	−13.8/ − 9.7*
Nifedipine GITS (30 mg, 8 wks)	180	−9.1/ − 5.8	−12.7/ − 7.6^‡	−9.9/ − 6.4	−12.7/ − 7.6	−7.8/ − 4.7	−12.6/ − 7.8^†

Note. All studies followed a prospective, randomized, open-label, blinded endpoint (PROBE) design. Participants of all studies (1565 individuals in total) were stage 1 and 2 essential hypertension patients, evaluated by 48-h ambulatory BP monitoring and wrist actigraphy before and after treatment. Comparison of effects on BP between treatment-times: *p < .001; ^†p < .01; ^‡p < .05.

^aHypertensive subjects treated with doxazosin GITS monotherapy.

^bHypertensive subjects treated with doxazosin GITS (in combination with other hypertension medications) as a polytherapy.

^cStudy on elderly hypertensive participants (≥60 yrs of age), large proportion being non-dipper subjects.

^dStudy on non-dipper hypertensive subjects evidencing sleep-time relative SBP decline index <10%. The sleep-time relative BP decline, an index of BP dipping, is defined as the percent decline in mean BP during the hours of nocturnal sleep relative to the mean BP during the hours of diurnal activity and calculated as: [(awake BP mean − asleep BP mean)/awake BP mean] × 100.