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Abstract: FR-PO370

Effect of Chronotherapy on BP Pattern and Renal Function in CKD III-IV: A RCT

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Tiwari, Vaibhav, ipgme&r, Kolkata, West Bengal, India
  • Sahu, Raju Kumar, IPGME&R Kolkata, Kolkata, India
Background

There is higher prevalence of non dipping pattern in antihypertensive CKD patients. we studied the effect of shifting antihypertensives to night time on blood pressure profile of CKD III-IV patients

Methods

Study Design: single centre, prospective, RCT
Setting and participants: CKD III-IV with non dipping pattern on ABPM
Intervention: the intervention group received all the antihypertensives in the night time, control group continued to take medication in the morning. Both groups were followed for 1 year
Outcomes: primary outcome was the reversion to dipper status. Secondary outcomes were changes in eGFR and cardiac structure.

Results

39 patients in bedtime group and 36 patients in awakening group were analysed. 10 patients (24%) reverted to dipping pattern in bedtime group as compared to none in the awakening group.Mean eGFR decrease from 34.59±12.43 to 34.41±11.82 ml/min/1.73m2 in Bedtime group (p=0.5), in awakening group eGFR decrease from 32.46±13.42 to 29.91±9.97 ml/min/1.73m2 (p=0.03). Between group difference in eGFRs was significant at 1 year (5.22[ 95% CI,4.3-6.1]ml/min/1.73m2; p= 0.02). Cardiac structure changes showed no significant changes in either group.

Conclusion

Bedtime administration of antihypertensives reverted non dippers to dippers and slowed the decline in eGFR in CKD III-IV compared to morning administration of antihypertensives.

Baseline Characteristics
VariablesAwakening groupBedtime group
Creatinine, mg/dL2.32±0.682.18±0.58
No. of hypertension medications2.58±1.12.67±0.96
Awake systolic mean, mmHg131.64±13.13133.31±13.47
Sleep systolic mean, mmHg124.94±13.14126.49±13.83
24 hour systolic mean, mmHg128.72±13.29130.92±13.21
Awake diastolic mean, mmHg84.36±11.6783.21±11.67
Asleep diastolic mean, mmHg76.31±12.5578.36±13.67
24 hour diastolic mean, mmHg79.28±11.4380.59±11.24

Flow diagram