If that AM pill box section overfloweth, consider moving one of the Blood Pressure (BP) meds from the AM to the bedtime slot. An open label trial randomized 661 patients with Chronic Kidney Disease (CKD) to take their antihypertensive meds either all at once upon awakening (AM Dosers) OR to take at least one of them at bedtime.Ambulatory BP’s (48 hour) were measured at baseline and 3 months after any adjustment or at least annually.
After a median follow-up of 5.4 years, bedtime dosers had an adjusted risk for total Cardiovascular (CV) events (composite of death, Myocardial infarction, angina pectoris, revascularization, HF. arterial occlusion of lower extremities, retinal artery occlusion and stroke) that was ~ 1/3 that of AM dosers (HR 0.31; 95% CI 0.21 to 0.46; P<0.001).
Bedtime dosers had a similar significant reduction in risk for composite outcome of CV death, Myocardial infarction (MI) or stroke. Bedtime dosing led to significantly lower mean sleep-time BP and more control of ambulatory BP (56% versus 45% P=0.003).
(Editorial comment-we wonder if bedtime dosing of ice cream has similar effects and plan a study)
Source: J Am Soc Nephrol 22:2313–2321, 2011