CHRONOTHERAPY IN CHRONIC KIDNEY DISEASE PATIENTS WITH HYPERTENSION: AN EVIDENCE-BASED MEDICINE REVIEW

• Autor(a) principal: Vieira Martins, Bernardo
• Data de Publicação: 2022
• Outros Autores: Aleixo, Ana Rita
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.58043/rphrc.49
• topic: Cronoterapia; Doença Renal Crónica; Anti-hipertensores; Morbimortalidade Cardiovascular; Chronotherapy; Chronic Kidney Disease; Antihypertensive Drugs; Cardiovascular Morbimortality

OBJECTIVE: This review’s goal is to evaluate, based on the best available evidence, the differences in blood pressure control, blood pressure profile and cardiovascular risk between administering antihypertensive drugs at bedtime (chronotherapy) compared to administering antihypertensives drugs at any other time, in a population of hypertensive chronic kidney disease patients not on renal replacement therapy and ascertain if that evidence is represented in the current guidelines. DATA SOURCES: The Cochrane Library, MEDLINE/PubMed, Direção Geral da Saúde, Sociedade Portuguesa de Nefrologia, Sociedade Portuguesa de Cardiologia, Sociedade Portuguesa de Hipertensão, National Institute for Health and Clinical Excellence, European Society of Hypertension-European Society of Cardiology, National Guideline Clearinghouse, Canadian Medical Association, American Journal of Kidney Diseases e Kidney Disease: Improving Global Outcomes. METHODS: Search of meta-analysis (MA), systematic reviews (SR), clinical trials and guidelines available in English, Portuguese and Spanish using the MeSH terms “Antihypertensive Agents”, “Drug Administration Schedule” and “Kidney Diseases” without limiting the time of the publication. The American Family Physician’s Strength of Recommendation Taxonomy (SORT) was used to assess the levels of evidence and the strength of recommendation. Articles that did not meet the purposes of this evidence-based review were excluded. RESULTS: A total of 52 scientific articles were found in the initial research, six of which met the inclusion criteria (one MA, one RS and four ECR). The guidelines search resulted in six clinical guidelines that were included in this review. The results show that, although the bedtime administration of anti-hypertensive drugs showed a similar daytime and 24-hour blood pressure reduction as the morning administration of these drugs, chronotherapy transforms nighttime blood pressure profiles from non-dipper/riser to dipper and significantly reduces the nighttime blood pressure and cardiovascular risk. The guidelines have no recommendation regarding the optimal schedule of administration of anti-hypertensive drugs. Two of them reference chronotherapy, raising the question of whether it translates into improvement of outcomes in chronic kidney disease patients or in long term cardiovascular benefits. CONCLUSION: The administration of antihypertensive drugs at bedtime may be encouraged in hypertensive patients with chronic kidney disease to decrease nighttime blood pressure and therefore reduce cardiovascular risk (strength of recommendation B), a fact that may suggest an update of the current guidelines.