Elsevier

Heart Failure Clinics

Volume 13, Issue 4, October 2017, Pages 759-773
Heart Failure Clinics

Bedtime Blood Pressure Chronotherapy Significantly Improves Hypertension Management

https://doi.org/10.1016/j.hfc.2017.05.010Get rights and content

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Key points

  • •

    Consistent evidence of numerous studies substantiates the asleep blood pressure (BP) mean derived from ambulatory BP monitoring (ABPM) is both an independent and a stronger predictor of cardiovascular disease (CVD) risk than are daytime clinic BP measurements or the ABPM-determined awake or 24-hour BP means.

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    Cost-effective adequate control of sleep-time BP is of marked clinical relevance.

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    Ingestion time, according to circadian rhythms, of hypertension medications of 6 different classes and their

Ingestion-time differences in pharmacodynamics of hypertension medications

The pharmacokinetics (PK) of hypertension medications are significantly influenced by the well-documented circadian rhythms in gastric pH, transport, and emptying; gastrointestinal motility; biliary function; glomerular filtration; hepatic enzyme activity; and organ (duodenum, liver, and kidney) blood flow.22, 23, 24 Statistically and clinically significant ingestion time (more specifically, circadian stage) differences in the pharmacodynamics (PD) of hypertension medications,25, 26, 27, 28, 29

Resistant Hypertension

Resistant hypertension (RH) constitutes a clear illustration of the clinical relevance of a chronotherapeutic strategy that takes into account circadian changes in the physiology and biochemistry of BP control and regulation. RH patients are at considerably greater risk for renal disease and insufficiency and CVD and stroke events than are patients whose BP is well controlled by medication.19, 63 According to present criteria,63 hypertension is designated as resistant to treatment when

Summary

The goal of all hypertension treatment strategies is reduction of SBP and DBP as a means of preventing end-organ injury and decreasing CVD, stroke, renal disease, and other life-threatening risks. Early outcome trials, based solely on daytime OBPM, report prevention of CVD events by BP-lowering treatment is consistent and, to a certain extent, independent of class of prescribed hypertension medications. However, such findings are based primarily on outcome trials that have involved the

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    Disclosure Statement: The authors have nothing to disclose.

    Sources of Support: Research supported by unrestricted grants from Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Spanish Government (PI14-00205); Ministerio de Ciencia e Innovación, Spanish Government (SAF2006-6254-FEDER; SAF2009-7028-FEDER); Consellería de Economía e Industria, Xunta de Galicia (09CSA018322PR); European Research Development Fund and Consellería de Cultura, Educación e Ordenación Universitaria, Xunta de Galicia (CN2012/251; CN2012/260; GPC2014/078); Atlantic Research Center for Information and Communication Technologies (AtlantTIC); and Vicerrectorado de Investigación, University of Vigo.

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