In hypertensive patients one should take at least one medication (but not a diuretic) be taken at bedtime rather than taking all medications in the morning.

In an open-label trial of 2156 hypertensive patients with or without chronic kidney disease randomly assigned to take all anti blood pressure drugs in the morning or to take at least one (non-diuretic) at night, bedtime dosing significantly reduced all-cause mortality and the incidence of major heart adverse events [1,2].

Failure of the blood pressure to fall by at least 10 percent during sleep is called “nondipping,” and is a stronger predictor of adverse cardiovascular outcomes than daytime blood pressure.

1. Chronobiol Int 2010; 27:1629.
2. J Am Soc Nephrol 2011; 22:2313.

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