Chronotherapy for Hypertension

Abstract

Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk. To more effectively reduce nocturnal blood pressure and still counteract the morning surge in blood pressure, a number of studies have examined moving one or more antihypertensives from morning to bedtime dosing. More recently, such studies of chronotherapy have studied comorbid populations including obstructive sleep apnea, chronic kidney disease, or diabetes. Here, we summarize major findings from recent research in this area (2013-2017). In general, nighttime administration of antihypertensives improved overall 24-h blood pressure profiles regardless of disease comorbidity. However, inconsistencies between studies suggest a need for more prospective randomized controlled trials with sufficient statistical power. In addition, experimental studies to ascertain mechanisms by which chronotherapy is beneficial could aid drug design and guidelines for timed administration.

Circadian dysfunction in the Q175 model of Huntington's disease: Network analysis

“…Office visits are unlikely to coincide with the expression of hypertension. This type of “masked” or nocturnal hypertension is associated with poor clinical outcomes as the symptoms are likely to be untreated and patients frequently develop organ damage prior to transitioning to sustained hypertension which can be detected (Bowles, Thosar, Herzig, & Shea, ; Franklin, O'Brien, & Staessen, ). Based on these data, HD patients should be strong candidates for 24‐hr BP monitoring, which is the best method for uncovering this type of hypertension.…”

Открытое Одноцентровое Исследования Эффективности Снижения Артериального Давления В Утренние Часы У Пациентов С Мягкой И Умеренной Артериальной Гипертензией С Контролируемым Офисным Давлением И Неконтролируемыми Пиками Артериального Давления В Утренние Ч

“…Крім того, важливим, на наш погляд, є зниження рівня підвищення САТ у ранкові години більше ніж на 10 мм рт.ст., що так само свідчить про достовірний вплив досліджуваного препарату на можливі патогенетичні механізми цього процесу -активацію симпатоадреналової системи [2,3].…”

Google trend analysis of climatic zone based Indian severe seasonal sensitive population

“…4 Entire India seasonal monthly RSV with benchmark were shown in thin grey lines and their corresponding seasonal moving average (4 months) from 2004 to 2017 were shown in four different colours labelled as MA in the brackets. Please note that sudden drop in the RSV with benchmark after 2010 was indicated to divide the period into I and II (dotted vertical line) on SCLD activity in the context of chronotherapy is underutilized and could be a major consideration to improve modern personalized medicine [43][44][45][46][47]. Our GT study also identified highly significant comorbid seasonal rhythm of periodicity of 3, 4 and 6 months in SCLD especially for asthma, obesity, fibrosis in the entire India.…”