BMJ  2004;328:167 (17 January), doi:10.1136/bmj.328.7432.167-a

Letter

Timing of drug treatment is crucial

The first 150 words of the full text of this article appear below.

EDITOR—Taylor in his letter asked if time of administration of ramipril in the HOPE study confounds the interpretation.¹ Those prescribing and those designing protocols for clinical trials should be asking at what time of day any drug is best taken. Patients with progressive kidney failure may be "responders" and stabilise kidney function with medication; but others are "nonresponders" progressing to dialysis or death.

Shaw, Davies, and I said in 1963 that deterioration might be a consequence of little or no fall in sleeping blood pressure.² I now often prescribe ramipril, and other drugs, as nocturnal or divided (night and morning) doses for patients who continue to progress. Most patients who presented with progressive kidney failure to my practice are now stabilised or improving.³ I have urged clinicians and clinical trialists to be more thoughtful about the time of administration of drugs in relation to biological rhythms, including the . . . [Full text of this article]

Mildura Nephrology, 186 Thirteenth Street, Mildura, VIC 3500, Australia mknapp@mbox.com.au

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