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Chronotherapy Non-Dipping CKD TIME Trial — ESENeph MCQ

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ModerateHypertensionChronotherapy Non-Dipping CKD TIME TrialESENeph

A 50-year-old man with CKD G3b has a 24-hour ambulatory blood pressure showing average 24-hour BP 126/78, average daytime 132/82, and average nighttime 128/76. The nighttime dip is only 3%. He is on Ramipril 10 mg taken in the morning. What adjustment might help the non-dipping pattern?

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Correct answer: A — Consider bedtime dosing of Ramipril – chronotherapy (taking at least one antihypertensive at bedtime) may improve nocturnal BP dipping and reduce cardiovascular risk; however evidence from the TIME trial (2022) showed no difference in outcomes from morning vs evening dosing overall

Non-dipping nocturnal BP (nocturnal fall <10% of daytime) is highly prevalent in CKD and associated with adverse cardiovascular outcomes. Chronotherapy (bedtime dosing of ≥1 antihypertensive) has been proposed to improve nocturnal dipping. The Hygia Chronotherapy Trial (2020) initially showed dramatic benefit but had methodological concerns. The larger TIME trial (2022, Lancet) showed no significant difference in cardiovascular outcomes between morning and evening dosing overall. Nevertheless, in individual patients with severe non-dipping, a trial of bedtime dosing is reasonable and is standard practice in many nephrology centres.

Reference: KDIGO 2021 – BP in CKD; TIME Trial – Lancet 2022