The Impact of Timing of Fixed Dose Triple Antihypertensive Combinations on Ambulatory Blood Pressure Monitoring Parameters

Introduction Re-establishing dipping physiology significantly reduces cardiovascular events. The aim was to investigate the effect of timing of fixed dose triple antihypertensive combinations on blood pressure (BP) control. Methods One hundred sixteen consecutive patients (62.7 +/- 10.7 years, 38 men) with grade II hypertension were randomized into four groups. Group 1 and Group 2 patients were given angiotensin converting enzyme inhibitor-based triple antihypertensive pills to be taken in the morning or evening, respectively while Group 3 and Group 4 patients were given angiotensin receptor blocker (ARB) based triple antihypertensive pills to be taken in the morning or evening, respectively. All patients underwent 24-h ambulatory BP monitoring 1 month after the initiation of treatment. Results There were not any significant differences in the characteristics, BP values and loads among groups. All patients in each group had good BP control. Dipping pattern in systolic BP was observed significantly less in Group 3 patients taking ARB in the morning (3 patients) compared to other groups (12 patients) in each group, [P = .025]. Similarly, dipping pattern in diastolic BP was observed significantly less in Group 3 patients (4 patients) compared to others (13 patients) in Group 1 and 15 patients in Group 2 and Group 4, [P = .008]. Nondipping pattern was significantly associated with taking ARB in the morning, even when adjusted by age, sex, and other comorbidities. Conclusion Fixed dose triple antihypertensive drug combinations enable good BP control regardless of the timing of drug while ARB-based ones may be taken in the evening to ensure dipping physiology.

Automated summary

This study aimed to investigate the effect of timing of fixed dose triple antihypertensive combinations on blood pressure control. The results showed that all patients had good blood pressure control regardless of the timing of drug administration. However, patients taking ARB-based triple antihypertensive pills in the morning had significantly less dipping pattern in blood pressure compared to other groups. Therefore, ARB-based drugs may be taken in the evening to ensure dipping physiology.