IMPACT OF BEDTIME ANTIHYPERTENSIVE MEDICATION AND SLEEP QUALITY ENHANCEMENT ON NON-DIPPER HYPERTENSION

Abstract

Non-dipper hypertension characterized by a lack of nocturnal blood pressure reduction is associated with adverse cardiovascular outcomes and poor sleep quality. The objective of the study is to evaluate efficacy of bedtime administration of antihypertensive drugs and the pharmacological treatment of the sleep quality. Materials and methods. The study was conducted at Ivano-Frankivsk National Medical University, involving 65 patients divided into three groups. Group 1 (n=18) received a fixed combination of perindopril (8 mg) and indapamide (2.5 mg) in the morning. Group 2 (n=25) received the same medication in the evening. Group 3 (n=22) received the medication plus a combination of L-tryptophan and vitamins (Pineal-Tens) in the evening. Patients were monitored for three months using ambulatory blood pressure monitoring (Cardiosense BP) and arterial stiffness assessment (Siemens NX3 Elite ultrasound). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Statistical analysis included Kruskal-Wallis, Chi-square, and Bonferroni tests. Results. Baseline characteristics were well-matched across groups. Post-treatment, Groups 2 and 3 showed significant reductions in nighttime systolic and diastolic blood pressure compared to Group 1. Group 3 exhibited significant improvements in subjective sleep quality, sleep duration, and habitual sleep efficiency. The proportion of non-dippers significantly decreased in Groups 2 and 3, indicating better circadian blood pressure regulation. Arterial stiffness, measured by pulse wave velocity, significantly improved in Groups 2 and 3. Conclusions: Evening administration of antihypertensive drugs significantly reduces nighttime blood pressure. The combination therapy with L-tryptophan and vitamins significantly improves sleep quality. Bedtime administration helps restore normal circadian blood pressure patterns and reduces arterial stiffness.