Effect of valsartan with bedtime dosing on chronic kidney disease patients with nondipping blood pressure pattern

Abstract

Nondipping blood pressure (BP) pattern is a potential independent risk factor for chronic kidney disease (CKD). Bedtime administration of valsartan is considered to normalize circadian rhythm and protect the kidneys and heart in CKD patients. However, more clinical trials are needed to confirm this benefit. Sixty patients with nondipping BP pattern and thirty patients with dipping BP pattern were enrolled in this study, and the patients with nondipping BP pattern were randomly divided into two groups and treated with bedtime or awakening doses of valsartan (80-320 mg). Nondipping BP patients treated with bedtime doses of valsartan showed a greater reduction in 24-hour proteinuria and bedtime proteinuria, a greater delayed decline in estimated glomerular filtration rate, and more protection against myocardial hypertrophy (P<.05) compared with patients with the nondipping BP pattern treated with the awakening dose (P<.05). This was similar to patients with dipping BP. No severe clinical complications were recorded in these patients. Valsartan with bedtime dosing in CKD patients with the nondipping BP pattern have better renal and cardiovascular protection. Antihypertensive "chronotherapy" may be useful in clinical practice for CKD patients.

© 2012 Wiley Periodicals, Inc.

Figures

Figure 1

Comparison of blood pressure after valsartan therapy in the three groups. (A) Changes in systolic blood pressure after valsartan therapy in the three groups. (B) Changes in diastolic blood pressure after valsartan therapy in the three groups. (C) Comparison of the ratio of bedtime/awakening systolic blood pressure after valsartan therapy in the three groups. (D) Comparison of the ratio of bedtime/awakening diastolic blood pressure after valsartan therapy in the three groups.

Figure 2

Comparison of the changes in glomerular filtration rate and proteinuria after valsartan therapy in the three groups. (A) Changes in glomerular filtration rate after valsartan therapy in the three groups. (B) Changes in proteinuria after valsartan therapy in the three groups.

Figure 3

Comparison of ultrasonography parameters after valsartan therapy in the three groups. (A) Changes in left ventricular mass index after valsartan therapy in the three groups. (B) Changes in left ventricular ejection fraction after valsartan therapy in the three groups. (C) Changes in E/A ratio after valsartan therapy in the three groups. (D) Changes in carotid intima‐media thickness after valsartan therapy in the three groups.