Do you recommend bedtime administration of antihypertensives in patients who exhibit nondipping on ambulatory blood pressure monitoring?

Most of the effective anti-hypertensive medications are long-acting, with therapeutic levels maintained for up to 72 hours between doses. From a pharmacokinetic perspective, dosing these meds (like amlodipine and chlorthalidone) at night would not make a difference. Data supporting nocturnal dosing ...

Those that are non dippers are associated with LVH. It would be reasonable to consider the nocturnal administration of meds. Despite this, I admittedly still focus on optimizing daytime blood pressure readings.

My patients have had improved blood pressure control with night time dosing with the exception of diuretics. However, obviously, not every person is the same, and depending on their AM and PM blood pressure monitoring the doses often have to be split to twice daily.