Uncontrolled blood pressure can lead to heart attacks paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse blood pressure and thickening of platelets are all higher in the early morning hours. Controlling early morning blood pressure can reduce cardiovascular mortality. According to a study published in the Journal of the American Society of Nephrology among patients with chronic kidney disease and high blood pressure taking at least one antihypertensive drug at bedtime significantly improves blood pressure control with an associated decrease in risk for cardiovascular events. The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years during that time patients who took at least 1 BP lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening. A similar significant reduction in cardiac deaths heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping. For each 5 mmHg decrease in mean sleep time systolic upper BP there was a 14 reduction in the risk for cardiovascular events during follow up. Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime but not morning treatment.

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