Background: Non-dipper hypertension is often characterized by a blunted decrease of nocturnal blood pressure (BP) and is associated with increased risk of target organ damage and cardiovascular (CV) events, while the optimal treatment strategy is yet to be established. This trial was designed to evaluate whether nocturnal BP reduction and arterial stiffness improvement differ from antihypertensive agents and time of administration.

Methods: Young and middle-aged adults (18–65 years) with non-dipper hypertension were randomly assigned to nifedipine GITS (gastrointestinal therapeutic system) 30 mg or amlodipine besylate 5 mg once daily for 8 weeks, either taken in the morning or at night. Dose was doubled at 4-week if BP is not at goal. Twenty-four hour ambulatory BP monitoring (ABPM) and arterial stiffness were evaluated before and after 8 weeks of pharmacotherapy. The primary efficacy measure was the average nighttime systolic BP reduction.

Results: A total of 98 non-dipper hypertensive patients (mean age 46.3 years) were randomized during Dec, 2016 and Dec, 2020, of whom 72 (73%) patients completed all ABPM and follow-up evaluations. Nighttime systolic BP significantly reduced at 8 weeks vs. baseline with nifedipine GITS or amlodipine, irrespective of dosing at nighttime (−9.9 vs −9.9 mmHg, P > 0.05) or daytime (−11.5 vs. −10.9 mmHg, P > 0.05). No difference was seen between these two agents, when combining the data of nighttime and daytime dosing together (−10.8 vs. −10.5 mmHg, respectively, P = 0.898). Daytime, 24-h systolic BP, diastolic BP at different time and pulse wave velocity reduced significantly and comparably, and recovery of dipping rhythm were similar among groups.

Conclusion: Nighttime dosing of long-acting antihypertensive preparations, nifedipine GITS or amlodipine demonstrated similar effects on nocturnal BP reduction, dipping rhythm restoration and arterial elasticity improvement in younger subjects with non-dipper hypertension. These effects were comparable with morning dosing.

背景：非杓型高血压通常以夜间血压（BP）下降缓慢为特征，并与靶器官损伤和心血管（CV）事件风险增加相关，而最佳治疗策略尚未确定。该试验旨在评估夜间血压降低和动脉僵硬度改善是否与抗高血压药物和给药时间不同。

方法：患有非杓型高血压的青壮年（18-65岁）被随机分配到硝苯地平GITS（胃肠道治疗系统）30毫克或苯磺酸氨氯地平5毫克，每天一次，持续8周，早上或晚上服用。如果血压未达到目标，则剂量在 4 周时加倍。在药物治疗 8 周之前和之后评估 24 小时动态血压监测 (ABPM) 和动脉僵硬度。主要疗效指标是夜间平均收缩压降低。

结果：2016年12月和2020年12月期间，共有98名非杓型高血压患者（平均年龄46.3岁）被随机分组​​，其中72名（73%）患者完成了所有ABPM和随访评估。无论夜间剂量如何，硝苯地平 GITS 或氨氯地平在第 8 周时的夜间收缩压与基线相比显着降低（-9.9 与 -9.9 mmHg，磷> 0.05）或白天（−11.5 与−10.9 mmHg，磷> 0.05）。当将夜间和白天给药数据结合在一起时，这两种药物之间没有发现差异（分别为 -10.8 和 -10.5 mmHg，磷= 0.898）。各组日间、24小时收缩压、不同时间舒张压及脉搏波速度均显着降低，且下降节律恢复相似。

结论：夜间服用长效抗高血压制剂、硝苯地平 GITS 或氨氯地平，对患有非杓状高血压的年轻受试者夜间血压降低、杓状节律恢复和动脉弹性改善具有相似的效果。这些效果与早晨给药相当。