This study aimed to probe the effects of low-dose
irbesartan and
hydrochlorothiazide in combination with
levamlodipine at different times on the circadian rhythm of blood pressure,
matrix metalloproteinases (
MMPs), and tissue inhibitors of
metalloproteinases (TIMPs) levels in patients with non-dipper
hypertension (NDH). In this prospective randomized controlled trial, 124 patients with NDH who visited our hospital between August 2018 and July 2021 were enrolled and divided into morning (62 patients) and night (62 patients) medication groups according to the random number table method. All patients received low-dose
irbesartan and
hydrochlorothiazide combined with
levamlodipine, with the morning medication group taking the medication between 7:00 and 10:00 and the night medication group taking the medication between 19:00 and 22:00 for 24 weeks. The effect of
antihypertensive medication in both groups was measured, and changes in ambulatory blood pressure, blood pressure circadian rhythm, left ventricular structure, vascular endothelial function,
MMPs, and TIMPs levels were observed before treatment initiation and after 24 weeks of treatment in both groups. The percentage of the dipper type was higher in the night medication group than in the morning medication group, while the percentage of the non-dipper type was lower in the morning medication group (p < .05). Low-dose
irbesartan and
hydrochlorothiazide combined with
levamlodipine at different times can effectively treat NDH, but bedtime dosing is more beneficial in reducing nocturnal blood pressure, reversing NDH, improving the circadian rhythm of blood pressure, left ventricular structure, regulating vascular endothelial function, increasing
MMPs levels, and reducing TIMP levels.