Evening versus morning dosing regimen drug therapy for chronic kidney disease patients with hypertension in blood pressure patterns: a systematic review and meta-analysis

Background Evening dosing regimen drug therapy on blood pressure (BP) control is used widely, but its clinical benefits and preservation or re-establishment of normal 24-hour BP dipping pattern in chronic kidney disease (CKD) patients is not known. Aims To investigate the effect of evening dosing regimen of antihypertensive drugs on blood pressure patterns to CKD patients with hypertension. Methods We did a systematic review by searching PUBMED, EMBASE, ASN-ONLINE, the Cochrane Library and the reference lists of relevant articles of published papers. All trials designed to evaluate the effects of evening versus morning dosing regimen drug therapy for CKD patients with hypertension were included. Meta-analysis was performed using random or fixed effects models. Results Five randomized controlled trials (RCTs) and one comparative study, including 3732 patients met the inclusion criteria. Compared with morning dosing regimen drug therapy, evening administration of antihypertensive medication was associated with a significant reduction of 40% in non-dipper BP patterns (risk ratio [RR], 95% CI, [0.43, 0.84]). We noted a significant decrease in nocturnal systolic blood pressure (SBP) (MD −3.17 mmHg, 95% CI, [−5.41, −0.94]), a significant reduction in nocturnal diastolic blood pressure (DBP) (MD −1.37 mmHg. 95% CI. [−2.05, −0.69]) and a significant increase in awake SBP (MD 1.15 mmHg, 95% CI, [0.10, 2.19]) in patients assigned to evening dosing regimen drug therapy group. Patients showed no significant differences for all-cause mortality and cardiovascular mortality. Conclusion This review shows that evening dosing regimen drug therapy could reverse non-dipper BP patterns in hypertensive CKD patients.