Does chronotherapy for essential hypertension matter by class? A
systematic review and meta-analysis
Abstract
Objectives The study was performed to evaluate the efficacy and safety
of chronotherapy of hypertension with different medications monotherapy
or a combination compared with traditional regimens Methods Three
databases including PubMed, EMBASE and the Cochrane Library were
searched, from the inception of each database to 10 April 2020. The
Review Manager 5.4 was adopted for meta-analyses and subgroup analyses.
The blood pressure delta (Δ) was used as mean of differences (MD) with
95% confidence intervals (CIs), and the estimated effect for events
estimates the 95% CIs for frequency of events. The adults with
essential hypertension were treated with chronotherapy and traditional
regimens. Results Twenty-eight RCTs, recruiting 1865 patients in
bedtime/evening dosing and 1867 in awakening/morning dosing, were
enrolled in this quantitative review. Meta-analysis showed no
significant differences for overall drug-related AEs (RR=0.81, P=0.17;
I2=41%), but an obvious reduction of risk for overall withdrawals
(RR=0.52, P=0.005; I2=0.0%) with bedtime dosing. No statistically
significant differences were noted for clinic BP and diurnal BP, but
24-hour (48-hour) BP, nocturnal BP, morning BP, and non-dippers (%)
showed obvious reductions, statistically. By class, there existed
different efficacy between 2 administrations, with great decrease in
nocturnal BP control and changes in circadian rhythm with RAAS blockers
monotherapy, but an all-day control of BP for CCBs and diuretics. With
regard to a combination, no significant differences in BP management
were detected and the data about beta-receptor blockers were limited.
Conclusions The safety and efficacy of chronotherapy in antihypertensive
drugs might be based on the classes.