Impact of angiotensin II receptor blockers on changes in office, central blood pressure and circadian blood pressure in relation to morning or evening reception

Main Article Content

O. L. Rekovets
Yu. M. Sirenko
O. O. Torbas
C. M. Kushnir
G. F. Prymak


The aim – to evaluate the effect of angiotensin II receptor blockers – olmesartan, azilsartan and telmisartan – taken in the morning or evening hours, on office, central blood pressure under daily monitoring and to assess circadian blood pressure.
Materials and methods. The study included 126 patients with mild to moderate hypertension that were selected to compare the effect of drug pharmacotherapy with angiotensin II receptor blockers – olmesartan, azilsartan and telmisartan on morning and evening hours. Patients were distributed into 6 groups: 1st group 20 patients taking olmesartan 20–40 mg in the morning, 2nd group – 20 patients taking olmesartan 20–40 mg in the evening hours, 3rd – 21 patients taking azilsartan 40–80 mg in the morning, 4th – 20 patients taking azilsartan 40–80 mg in the evening, 5th – 22 patients taking telmisartan 40–80 mg in the morning, 6th – patients taking telmisartan 40–80 mg in the evening. Patients underwent primary and re-examination followed 3 months of the therapy.
Results and discussion. Lowering of office SBP/DBP in the olmesartan intake group in the evening hours was – 20.95/13.50 mm Hg (p<0.05), and when taken in the morning hours – 19.40/8.95 mm Hg (p<0.05). In the group of azіlsartan therapy, the lowering of office SBP/DBP in the evening hours was 21.10/11.50 mm Hg (p<0.05), and taken in the morning hours – 20.05/12.23 mm Hg (p<0.05). In the telmisartan intake group, the lowering of office SBP/DBP during in the evening was 19.54/9.00 mm Hg (p<0.05), and taken in the morning hours – 21.22/12.29 mm Hg (p<0.05). Lowering of central blood pressure was equally effective and did not depend on the time of taking the drugs. Lowering of central SBP with olmesartan intake was 3 months after administration in the evening hours – 18.34 mm Hg, in the morning – 15.22 mm Hg, while taking azilsartan – respectively 15.59 and 19.24 mm Hg, while taking telmisartan – respectively 12.00 and 18.00 mm Hg. Reaching of the target office blood pressure with olmesartan therapy was observed in 77.50 % of patients, with azilsartan in 78.05 % of patients, and with telmisartan in 78.57 % of patients. The intake of olmesartan, azilsartan and telmisartan did not statistically significantly affect the circadian blood pressure.
Conclusions. The use of olmesartan, azilsartan and telmisartan equally effectively lowered office and central blood pressure when taken both in the morning and evening hours, and did not have a statistically significant effect on changes in blood circadian pressure.


Article Details


arterial hypertension, chronotherapy, circadian rhythm, evening taken, morning taken.


Albrecht U. Timing to perfection: the biology of central and peripheral clocks. Neuron. 2012;74:246e60.

Bartter FC, Delea CS, Baker W. Chronobiology in the diagnosis and treatment of hypertension. Chronobiologia. 1976;3(3):199–213.

Bowles NP, Thosar SS, Herzig MX, Shea SA. Chronotherapy for Hypertension. Current Hypertension Reports. 2018;20:97.

Duguay D, Cermakian N. The crosstalk between physiology and circadian clock proteins. Chronobiol. Int. 2009;26:1479–1513.

Hermida R., Ayala D., Mojón A. et al. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study // Chronobiol. Int.– 2010.– Vol. 27 (8).– P. 1629–1651.

Hermida RC, Ayala DE, Fernández JR, Mojón A, Crespo JJ, Ríos MT, Smolensky MH. Bedtime blood pressure chronotherapy significantly improves hypertension management. Heart Failure Clin. 2017. Oct;13(4):759-773. 1551-7136/17.

Hermida RC, Ayala DE, Mojón A, Fernández JR. Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial. Diabetologia. 2016;59:255–265.

Hermida RC, Ayala DE, Mojón A, Fernández JR. Prognostic marker of type 2 diabetes and therapeutic target for prevention. Diabetologia. 2016;59:244–254.

Hermida RC, Ayala DE, Mojón A, Fernández JR. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J. Am. Soc. Nephrol. 2011;22(12):2313–2321.

Hermida RC, Ayala DE, Mojón A, Fernández JR. Effects of time of antihypertensive treatment on ambulatory blood pressure and clinical characteristics of subjects with resistant hypertension. Am. J. Hypertens. 2010;23:432–439.

Hermida RC1, Ayala DE, Mojón A, Fernández JR. Influence of time of day of blood pressure – lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care. 2011;34(6):1270–1276.

Hermida RC, Smolensky MH, Ayala DE, Portaluppi F. Ambulatory blood pressure monitoring (ABPM) as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults. Chronobiol. Int. 2015;32:1329–1342.

Jatoi NA, Mahmud A, Bennett K, Feely J. Assessment of arterial stiffness in hypertension: comparison of oscillometric (Arteriograph), piezoelectronic (Complior) and tonometric (SphygmoCor) techniques // J. Hypertens. 2009;27(11):2186–2191.

Judd E, Calhoun D. Management of Hypertension in CKD: Beyond the Guidelines. Adv. Chronic. Kidney Dis. 2015;22(2):116–122.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. Suppl. 2013;3:100–150.

Manfredini R, Fabbian F. A pill at bedtime, and your heart is fine? Bedtime hypertension chronotherapy: an opportune and advantageous inexpensive treatment strategy. Sleep. Med. Rev. 2017;33:1–3.

Matsui Y, Eguchi K, O'Rourke MF, Ishikawa J, Miyashita H, Shimada K, Kario K. Differential effects between a calcium channel blocker and a diuretic when used in combination with angiotensin II receptor blocker on central aortic pressure in hypertensive patients. Hypertension. 2009;54:716–723.

Mitchell GF, Hwang Shih-Jen, Vasan RS. Arterial stiffness and cardiovascular events: the Framingham heart study. Circulation. 2010;121(4):505–511.

Orías M, Correa-Rotter R. Chronotherapy in hypertension: a pill at night makes things right? J. Am. Soc. Nephrol. 2011;22(12):2152–2155. doi: 10.1681/ASN.2011101012.

Rahman M, Greene T, Phillips RA. A Trial of two strategies to reduce nocturnal blood pressure in african americans with chronic kidney disease. Hypertension. 2013;61(1):82–88.

Reppert SM, Weaver DR. Coordination of circadian timing in mammals. Nature. 2002;418:935e41.

Shen Y, Lu X. Clinical study of taking medicine at bedtime for CKD patients to reduce cardiovascular events. Mod. Instrum. Med. Treatment. 2014;20:89–91.

Sleight P. The HOPE Study (Heart Outcomes Prevention Evaluation). J. Renin. Angiotensin Aldosterone Syst. 2000;1(1):18–20.

Smolensky MH, Hermida RC, Ayala DE, Portaluppi F. Bedtime hypertension chronotherapy: concepts and patient outcomes. Curr. Pharm. Des. 2015;21(6):773–790.

Smolensky MH, Hermida RC, Ayala DE, Mojón A, Fernández JR. Bedtime Chronotherapy with Conventional Hypertension Medications to Target Increased Asleep Blood Pressure Results in Markedly Better Chronoprevention of Cardiovascular and Other Risks than Customary On-awakening Therapy. Heart Failure Clin. 2017. Oct;13(4):775-792.

Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, Forette F, Leonetti G, Nachev C, O'Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto J, Zanchetti A. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350(9080):757–764.

Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin- converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. New Engl. J. Med. 2000;342:145–153.

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