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Peer-reviewedCC BY-NC 4.0The Journal of Clinical Hypertension

Beyond Mean Blood Pressure Reduction: Distributional and Responder Effects of Bedtime Antihypertensive Dosing in Nondipping Hypertension. A Secondary Analysis of a Randomized Controlled Study

  • Raymond Farah1,2
  • Nicola Luigi Bragazzi3,4,5
  • Halil Ibrahim Ceylan6
  • Nader Ballout1,2
  • Tony Hanna1,2
  • Rola Khamisy‐Farah7,8
8 affiliations
  1. 1Department of Internal Medicine B Ziv Medical Center Safed Israel
  2. 2Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
  3. 3Laboratory For Industrial and Applied Mathematics Department of Mathematics and Statistics York University Toronto Ontario Canada
  4. 4Postgraduate School of Public Health Department of Health Sciences University of Genoa Genoa Italy
  5. 5UNESCO Chair Health Anthropology Biosphere and Healing Systems University of Genoa Genoa Italy
  6. 6Physical Education and Sports Teaching Department Faculty of Sports Sciences Atatürk University Erzurum Türkiye
  7. 7Clalit Health Services Akko Israel
  8. 8Azrieli Faculty of Medicine Bar‐Ilan University, Galilee Safed Israel
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Abstract

Mean blood pressure (BP) differences do not fully characterize treatment response. We examined adjusted BP, target attainment and change distributions after morning versus bedtime antihypertensive dosing. This post hoc secondary analysis of a randomized controlled trial included 60 patients with uncontrolled hypertension and a nondipping pattern, assigned to morning or bedtime dosing (30 per group). Two‐month systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were compared using baseline‐adjusted analysis of covariance. Secondary analyses assessed BP <140/90 mmHg and median and trimmed changes. Adjusted bedtime‐minus‐morning differences were −18.1 mmHg for SBP (95% CI −22.4 to −13.8), −11.6 mmHg for DBP (−14.5 to −8.8) and −13.9 mmHg for MAP (−16.7 to −11.0); all p < 0.001. Bootstrap intervals were similar. BP <140/90 mmHg was achieved by 29/30 (96.7%) versus 3/30 (10.0%) patients (risk ratio 9.67; 95% CI 3.30–28.34). Median SBP and DBP change differences were −9.5 and −3.0 mmHg, respectively, with confidence intervals including zero. Bedtime dosing was associated with lower adjusted two‐month BP and greater target attainment. Change‐based estimates were less precise, indicating uncertainty about the distribution of response. These exploratory findings from a small randomized trial warrant prospective confirmation.

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Cite

BibTeXRIS
BibTeX
@article{farah2026beyond,
  title = {{Beyond Mean Blood Pressure Reduction: Distributional and Responder Effects of Bedtime Antihypertensive Dosing in Nondipping Hypertension. A Secondary Analysis of a Randomized Controlled Study}},
  author = {Raymond Farah and Nicola Luigi Bragazzi and Halil Ibrahim Ceylan and Nader Ballout and Tony Hanna and Rola Khamisy‐Farah},
  journal = {The Journal of Clinical Hypertension},
  year = {2026},
  month = oct,
  doi = {10.1111/jch.70372},
  url = {https://doi.org/10.1111/jch.70372},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Beyond Mean Blood Pressure Reduction: Distributional and Responder Effects of Bedtime Antihypertensive Dosing in Nondipping Hypertension. A Secondary Analysis of a Randomized Controlled Study
AU  - Raymond Farah
AU  - Nicola Luigi Bragazzi
AU  - Halil Ibrahim Ceylan
AU  - Nader Ballout
AU  - Tony Hanna
AU  - Rola Khamisy‐Farah
PY  - 2026
DA  - 2026/10/01
JO  - The Journal of Clinical Hypertension
DO  - 10.1111/jch.70372
UR  - https://doi.org/10.1111/jch.70372
AB  - Mean blood pressure (BP) differences do not fully characterize treatment response. We examined adjusted BP, target attainment and change distributions after morning versus bedtime antihypertensive dosing. This post hoc secondary analysis of a randomized controlled trial included 60 patients with uncontrolled hypertension and a nondipping pattern, assigned to morning or bedtime dosing (30 per group). Two‐month systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were compared using baseline‐adjusted analysis of covariance. Secondary analyses assessed BP <140/90 mmHg and median and trimmed changes. Adjusted bedtime‐minus‐morning differences were −18.1 mmHg for SBP (95% CI −22.4 to −13.8), −11.6 mmHg for DBP (−14.5 to −8.8) and −13.9 mmHg for MAP (−16.7 to −11.0); all p < 0.001. Bootstrap intervals were similar. BP <140/90 mmHg was achieved by 29/30 (96.7%) versus 3/30 (10.0%) patients (risk ratio 9.67; 95% CI 3.30–28.34). Median SBP and DBP change differences were −9.5 and −3.0 mmHg, respectively, with confidence intervals including zero. Bedtime dosing was associated with lower adjusted two‐month BP and greater target attainment. Change‐based estimates were less precise, indicating uncertainty about the distribution of response. These exploratory findings from a small randomized trial warrant prospective confirmation.
SN  - 1524-6175
SN  - 1751-7176
ER  -