The impact of acetylsalicylic acid dosed at bedtime on circadian rhythms of blood pressure in the high-risk group of cardiovascular patients-a randomized, controlled trial

Abstract

Purpose: Time of drug administration may significantly influence its effect. The aim of the present study was to investigate the effect of ASA (administrated in the morning or in the evening) on the anti-hypertensive effect and diurnal blood pressure profile in the high-risk group of cardiovascular patients.

Methods: All patients (n = 114) had been diagnosed with coronary heart disease and arterial hypertension prior to the enrolment and had been treated with 75 mg per day of ASA in the morning. The patients were randomly assigned to one of the two study groups receiving 75 mg of ASA per day in a single antiplatelet therapy for 3 months in the morning (n = 58) or in the evening (n = 56). The control group (n = 61) consisted of patients with arterial hypertension but without coronary heart disease, not receiving ASA. In all the patients, during each visit, clinical blood pressure (BP) and ambulatory blood pressure measurements (ABPM) were performed.

Results: There was a significant reduction in 24-h BP and blood pressure at night in the ASA group evening group compared with the ASA morning group and the control group.

Conclusions: The present study demonstrated that compared with the use of ASA in the morning, its administration in the evening may lead to favourable drop in the ABPM and an improvement of the diurnal profile in the high-risk group of cardiovascular patients who are not naïve to ASA.

Keywords: Acetylsalicylic acid; Anti-hypertensive effect; Bedtime administration; Chronotherapy; Circadian rhythm; Randomized controlled trial.

Fig. 1

Scheme of the study. Following measurements were performed in each group: laboratory tests, abdominal ultrasound examination, abdominal CT scan, Doppler ultrasound of renal arteries, clinical BP (3x/24 h), ABPM, ECG, echocardiography, weight, and body mass index assessment

Fig. 2

Changes of nocturnal blood pressure fall between Visit 1 and Visit 2 in the studied groups (p value refers to Wilxocon-signed rank test)

Fig. 3

The number of non-dipping, dipping, and extremely dipping patients in the studied groups during the Visit 1 and Visit 2 (p value refers to Fisher’s exact test)