背景:抗高血压药的给药时机存在争议。目的是比较早上和晚上服用抗高血压药物的疗效。
方法:PubMed,EMBASE,和clinicaltrials.gov数据库搜索抗高血压治疗的随机临床试验,其中患者被随机分为早上和晚上给药。结果为动态血压(BP)参数(白天,夜间,和24/48小时收缩压[SBP]和舒张压[DBP])和心血管结局。
结果:在72项随机对照试验中,晚上给药显着降低动态血压参数:24/48小时SBP(平均差异[MD]=1.41mmHg;[95%CI,0.48-2.34]),DBP(MD=0.60mmHg[95%CI,0.12-1.08]),夜间SBP(MD=4.09mmHg[95%CI,3.01-5.16]),DBP(MD,2.57mmHg[95%CI,1.92-3.22]),日间SBP下降幅度较小(MD=0.94mmHg[95%CI,0.01-1.87]),和DBP(MD=0.87mmHg[95%CI,0.10-1.63]),与早晨给药相比,心血管事件在数字上更低。然而,当Hermida有争议的数据(23项试验,25734例患者)被省略(大多数结果的异质性<0.05),上述夜间给药效果减弱,对24/48小时动态血压无明显影响,日间BP,主要不良心脏事件和夜间动态SBP和DBP的降低较小。
结论:夜间服用降压药可显著降低动态血压参数,降低心血管事件,但其效果主要由Hermida组的试验驱动。除非目的是特别降低夜间血压,抗高血压药物应在一天中方便的时间服用,优化依从性,并最大限度地减少不良影响。
The timing of antihypertensive drugs administration is controversial. The aim was to compare the efficacy of dosing of antihypertensive drugs in the morning versus evening.
A PubMed, EMBASE, and clinicaltrials.gov databases search for randomized clinical trials of antihypertensive therapies where patients were randomized to morning versus evening dosing. The outcomes were ambulatory blood pressure (BP) parameters (day-time, night-time, and 24/48-hour systolic blood pressure [SBP] and diastolic blood pressure [DBP]) and cardiovascular outcomes.
Of 72 randomized controlled trials included, evening dosing significantly reduced ambulatory BP parameters: 24/48-hour SBP (mean difference [MD]=1.41 mm Hg; [95% CI, 0.48-2.34]), DBP (MD=0.60 mm Hg [95% CI, 0.12-1.08]), night-time SBP (MD=4.09 mm Hg [95% CI, 3.01-5.16]), DBP (MD, 2.57 mm Hg [95% CI, 1.92-3.22]), with a smaller reduction in day-time SBP (MD=0.94 mm Hg [95% CI, 0.01-1.87]), and DBP (MD=0.87 mm Hg [95% CI, 0.10-1.63]), and numerically lower cardiovascular events compared with morning dosing. However, when controversial data by Hermida (23 trials, 25 734 patients) were omitted (Pheterogeneity<0.05 for most outcomes), the above effect of evening dosing attenuated with no significant effect on 24/48-hour ambulatory blood pressure, day-time BP, and major adverse cardiac event and smaller reduction in night-time ambulatory SBP and DBP.
Evening dosing of antihypertensive drugs significantly reduced ambulatory BP parameters and lowered cardiovascular events but the effect was mainly driven by trials by Hermida group. Unless the intention is to specifically lower night-time BP, antihypertensive drugs should be taken at a time of day that is convenient, optimizes adherence, and minimizes undesirable effects.