Chronobiologie des Blutdrucks und Chronopharmakotherapie der arteriellen Hypertonie

Abstract

Arterial blood pressure is subject to a circadian rhythm that results in a fall of blood pressure during the night. In patients with diabetes, renal insufficiency, left-ventricular hypertrophy, sleep apnea, hypertension of pregnancy, and different forms of secondary hypertension a nocturnal fall of blood pressure is even abandoned or reverted. Diagnosis is made using 24-h blood pressure measurement, which is however used not frequently enough for a clinical assessment or adjustment of therapy. An adaption of the selection or the time of administration of antihypertensive drugs with respect to the circadian rhythm is beneficial to control blood pressure and reduce cardiovascular morbidity. This is particularly true for patients with an a non- or inverted dipping blood pressure pattern, in which the bedtime dosing may result in a normalization of blood pressure and restoration of a normal circadian rhythm. The present manuscript reviews the chronopharmacotherapy of arterial hypertension and grant practical recommendations for their translation into clinical practice.

Role of Circadian Rhythm and Impact of Circadian Rhythm Disturbance on the Metabolism and Disease

“…98 Of course, each patient has a different system, and their compliance also needs to be considered because not every patient is suitable for taking medicine at night. 96 In addition, in the diagnosis and treatment of hypertension, 24-h ambulatory blood pressure measurement can effectively prevent cardiovascular disease and hypertension syndrome compared with a single clinical blood pressure measurement. 98 In short, it is a useful approach to consider the circadian rhythm pattern of blood pressure when treating hypertension by chronotherapy.…”

“…Studies of antihypertensive drugs, such as diuretics, calcium antagonists, angiotensin-converting enzyme, and angiotensin receptor blockers, have shown that they are more effective when taken at night and often normalize coupling behavior. 96 Compared with the morning, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers ingestion schedule in the evening exerts a greater therapeutic effect on relative blood pressure decline in sleep time. 97 Additionally, telmisartan was shown to be more effective in controlling early morning blood pressure fluctuations than short-acting angiotensin II receptor blockers.…”