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Differential Effects of Morning or Evening Dosing of Amlodipine on Circadian Blood Pressure and Heart Rate

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Abstract

Objectives: To compare the effects of morning and evening dosing of amlodipine on both circadian blood pressure (BP) and heart rate (HR) in mild-to-moderate essential hypertension.

Design: A perspective, double-blind, randomized, crossover design with dose titration.

Patients and methods: Sixty-two patients recruited in the study were aged 21–77 years and had mild-to-moderate essential hypertension. At the end of a 2-week single-blind, placebo run-in period, eligible patients were randomly assigned to morning (7 AM) and evening (9 PM) amlodipine treatment. The initial dose was 5 mg. After 2 weeks of double-blind therapy, patients with a seated diastolic blood pressure ≥90 mm Hg had their doses titrated upward to 10 mg, while the other patients remained on their original 5 mg doses for another 4 weeks period, than crossover to the alternate dosing regimen for 6 additional weeks. The 24-h ambulatory monitoring was performed at baseline and at 6 and 12 weeks after randomization.

Results: 24-h diastolic BP load (11.0 ± 17.5% vs. 6.5 ± 9.1%, P < 0.05) and night-time BP load (28.5 ± 31.4%/17.7 ± 28.2% vs. 20.0 ± 27.9%/9.2 ± 17.8%, P < 0.05/0.05) were significantly greater with evening dosing compared with morning dosing. Nocturnal fall of BP was greater with morning dosing than with evening dosing (9.8 ± 6.7/7.4 ± 5.3 vs. 6.7 ± 6.6/5.4 ± 5.4 mm Hg, P < 0.01/0.05). Percentage of nocturnal BP fall was greater with morning dosing versus with evening dosing (7.9 ± 5.3%/9.6 ± 6.8% vs. 5.4 ± 7.0%/7.0 ± 6.9%, P < 0.01/0.05).

Conclusions: Morning administered amlodipine had a better effect on the circadian BP compared with evening administrated amlodipine in mild-to-moderate essential hypertension.

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Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital, Zhejiang University, College of Medicine, Hangzhou, P.R. China

    Yuan-Gang Qiu, Jun-Zhu Chen, Jian-Hua Zhu & Xue-Yan Yao

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  1. Yuan-Gang Qiu
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  2. Jun-Zhu Chen
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  3. Jian-Hua Zhu
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Qiu, YG., Chen, JZ., Zhu, JH. et al. Differential Effects of Morning or Evening Dosing of Amlodipine on Circadian Blood Pressure and Heart Rate. Cardiovasc Drugs Ther 17, 335–341 (2003). https://doi.org/10.1023/A:1027347723347

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