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The ONTARGET ABPM substudy did not find ramipril/telmisartan renin–angiotensin system double blockade better enhanced cardiovascular and renal protection than either medication alone, despite markedly greater 24-hour and daytime BP attenuation, because of inability to effectively control nighttime BP. Thus, the potential benefits of the greater daytime BP reduction seem to have been offset by unfavorable enhancement of nondipping.\udThe discussed ONTARGET findings stress the critical importance of sleep BP in the routine management of every hypertensive patient and constitute pervasive evidence against the routine practice of recommending morning ramipril and telmisartan ingestion

Nondipping and Cardiovascular Risk After Morning Renin–Angiotensin Blockade