TIME-DEPENDENT EFFECT OF ISRADIPINE ON THE NOCTURNAL HYPERTENSION IN CHRONIC-RENAL-FAILURE

Nocturnal hypertension is frequently observed in chronic renal failure and contributes to the risk of target organ damages. We assessed whet her antihypertensive therapy may restore a nocturnal blood pressure (B P) fall in this condition. A sustained-release oral formulation (SRO) of isradipine was used, and the possible differences in the response t o morning v evening dosing were also investigated. Sixteen hypertensiv e patients with chronic renal failure due to parenchymal kidney diseas e were studied after 2 weeks of single-blind placebo run-in. According to the double-blind, randomized, cross-over design, they received 5 m g isradipine SRO at 08:00, or at 20:00 for 4 weeks, separated by a sin gle-blind placebo period of 2 weeks. A 24-h BP monitoring at 10-min in tervals was carried out at the end of each treatment using a SpaceLabs 90207 instrument. Under placebo, blunt BP profiles were observed, whe reas HR showed a mean nocturnal fall of 17.4%, which remained unaltere d after isradipine. Both isradipine treatments were equally effective in reducing the mean 24-h BP levels. However, the evening regimen show ed a more pronounced effect during the night. The mean nocturnal fall in systolic/diastolic BP represented 4.8/ 8.7% and 7.5/10.9% of the co rresponding daytime mean after morning and evening dosing, respectivel y. Only the evening administration reset the normal synchronization of the 24-h BP and HR profiles. Our findings demonstrate that antihypert ensive treatment may restore a nocturnal BP fall in renal patients. An evening regimen of isradipine SRO seems more apt than a morning regim en to obtain this therapeutic goal.