Circadian Rhythm and Environmental Determinants of Blood Pressure Regulation in Normal and Hypertensive Conditions

Portaluppi, Francesco; Smolensky, Michael H.

doi:10.1007/978-1-59259-004-9_5

Cited by 31 publications

(10 citation statements)

References 468 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, a prominent circadian variation has been demonstrated for plasma renin activity, ACE, angiotensin II, aldosterone, atrial natriuretic peptide, and catecholamines (Angeli et al, 1992;Portaluppi & Smolensky, 2000), all reflecting the marked circadian structure of the RAAS. Plasma renin activity peaks during nighttime sleep and is lowest in the early afternoon (Bartter et al, 1979).…”

Section: Discussionmentioning

confidence: 98%

“…The majority of biological processes is controlled by a master (brain) and peripheral (organ and tissue) clock network (Duguay & Cermakian, 2009), and accordingly the main steps in the mechanisms regulating BP are circadian-stage-dependent (Portaluppi & Smolensky, 2000). Thus, it is not surprising that antihypertensive medications display a circadian time-dependency in their pharmacokinetics (PK) and pharmacodynamics (PD) (Hermida et al, 2007a).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Administration-Time-Dependent Effects of Spirapril on Ambulatory Blood Pressure in Uncomplicated Essential Hypertension

Hermida

Ayala

Fontao

et al. 2010

Chronobiology International

View full text Add to dashboard Cite

The administration of most angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) at bedtime results in a greater reduction of nighttime blood pressure (BP) than dosing upon awakening. It has been proposed that this effect may be a consequence of a short half-life and duration of action. However, those findings were also documented for long-acting medications, such as the ARB telmisartan. Accordingly, we investigated the administration-time-dependent effects on ambulatory BP of spirapril, an ACEI with an elimination half-life of about 40 h. We studied 165 previously untreated hypertensive subjects, 42.5 +/- 13.9 yrs of age, treated with spirapril (6 mg/day) as monotherapy for 12 weeks either upon awakening or at bedtime. BP was measured by ambulatory monitoring for 48 h before and after treatment. The BP reduction during diurnal activity was similar for both treatment times. Bedtime spirapril administration, however, was significantly more efficient than morning administration in reducing asleep BP. The awake/asleep BP ratio was decreased with the upon-awakening spirapril treatment schedule but significantly increased toward a more dipping pattern with the bedtime treatment schedule. The proportion of patients with controlled ambulatory BP increased from 23 to 59% (p < 0.001) with bedtime treatment. Sleep-time BP regulation is significantly better achieved with bedtime spirapril administration. This might be clinically important, as the sleep-time BP mean has been shown to be a more relevant marker of cardiovascular risk than the awake mean values. These administration-time-dependent effects of spirapril seem to be a class-related feature, and may be associated with the nocturnal activation of the renin-angiotensin-aldosterone system.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Administration-Time-Dependent Effects of Spirapril on Ambulatory Blood Pressure in Uncomplicated Essential Hypertension

Hermida

Ayala

Fontao

et al. 2010

Chronobiology International

View full text Add to dashboard Cite

show abstract

“…In adults, SBP and DBP may vary by as much as 50 mmHg and HR by 25 beats/minute throughout 24 h, as a result of circadian changes in underlying biological functions as well as day-night differences in environmental conditions and loads [53][54][55]. However, BP is also affected by a variety of external factors including ambient temperature/humidity, physical activity, emotional state, alcohol, caffeine or meal consumption, and sleep/wake routine [55,58,59]. However, BP is also affected by a variety of external factors including ambient temperature/humidity, physical activity, emotional state, alcohol, caffeine or meal consumption, and sleep/wake routine [55,58,59].…”

Section: Circadian Bp Variability In Pregnant and Nonpregnant Womenmentioning

confidence: 99%

Prognostic value of ambulatory blood pressure measurements for the diagnosis of hypertension in pregnancy

Hermida¹,

Ayala

2004

Expert Review of Cardiovascular Therapy

View full text Add to dashboard Cite

Several studies have indicated that the use of the 24 h mean blood pressure, mainly using reference thresholds derived from general nonpregnancy practice, does not provide an effective test for an individualized early diagnosis of hypertension in pregnancy, thus concluding that ambulatory blood pressure monitoring is not a valid approach in pregnancy. With the use of ambulatory blood pressure monitoring, epidemiologic studies have reported gender differences in the circadian variability of blood pressure and heart rate. Typically, men exhibit a lower heart rate and higher blood pressure than women, the differences being larger for systolic than for diastolic blood pressure. Moreover, normotensive and hypertensive pregnant women are characterized by differing but predictable patterns of blood pressure variability throughout gestation. However, the diminished blood pressure in nongravid women as compared with men, the added decrease in blood pressure during the second trimester of gestation in normotensive but not in hypertensive pregnant women and the large amplitude of the circadian pattern that characterizes the blood pressure of healthy pregnant women at all gestational ages, have not been taken into account when establishing reference thresholds for the diagnosis of hypertension in pregnancy. This review will describe these issues, summarize previous results from independent groups on the prognostic value of ambulatory blood pressure monitoring in pregnancy, propose answers as to an accurate reference threshold for blood pressure at different stages of gestation and suggest how this information should be used in order to identify those women at a higher risk of hypertension, who will also be more suitable for prophylactic and/or therapeutic intervention in the early stages of pregnancy.

show abstract

“…This circadian variation in BP represents, on the one hand, the influence of internal factors such as ethnicity, gender, autonomic nervous system tone, vasoactive hormones, and hematologic and renal variables (Lemmer 1992; Sica and Wilson 2000). On the other hand, BP is affected by a variety of external factors including ambient temperature/humidity, physical activity, emotional state, alcohol or caffeine consumption, meal composition, and sleep/wake routine (Baumgart 1991; Portaluppi and Smolensky 2000; Hermida et al 2002). …”

Section: Introductionmentioning

confidence: 99%

“…Because the main steps in the mechanisms regulating BP are circadian-grade-dependent (Portaluppi and Smolensky 2000), it is not surprising that antihypertensive medications may display a circadian time-dependency in their pharmacokinetics and effects (Lemmer 2000; Hermida and Smolensky 2004). Chronotherapeutics has been defined as the purposeful timing of medications to proportion their serum and tissue concentrations in synchrony with known circadian rhythms in disease processes and symptoms as a means of enhancing beneficial outcomes and/or attenuating or averting adverse effects (Smolensky and Haus 2001).…”

Section: Introductionmentioning

confidence: 99%

Optimal timing for antihypertensive dosing: focus on valsartan

Hermida¹,

Ayala²,

Calvo³

2007

Therapeutics and Clinical Risk Management

View full text Add to dashboard Cite

Some specific features of the 24 h blood pressure (BP) pattern are linked to the progressive injury of target tissues and the triggering of cardiac and cerebrovascular events. In particular, many studies show the extent of the nocturnal BP decline relative to the diurnal BP mean (the diurnal/nocturnal ratio, an index of BP dipping) is deterministic of cardiovascular injury and risk. Normalization of the circadian BP pattern is considered to be an important clinical goal of pharmacotherapy because it may slow the advance of renal injury and avert end-stage renal failure. The chronotherapy of hypertension takes into account the epidemiology of the BP pattern, plus potential administration-time determinants of the pharmacokinetics and dynamics of antihypertensive medications, as a means of enhancing beneficial outcomes and/or attenuating or averting adverse effects. Thus, bedtime dosing with nifedipine gastrointestinal therapeutic system (GITS) is more effective than morning dosing, while also reducing significantly secondary effects. The dose-response curve, therapeutic coverage, and efficacy of doxazosin GITS are all markedly dependent on the circadian time of drug administration. Moreover, valsartan administration at bedtime as opposed to upon wakening results in improved diurnal/nocturnal ratio, a significant increase in the percentage of patients with controlled BP after treatment, and significant reductions in urinary albumin excretion and plasma fibrinogen. Chronotherapy provides a means of individualizing treatment of hypertension according to the circadian BP profile of each patient, and constitutes a new option to optimize BP control and reduce risk.

show abstract

Circadian Rhythm and Environmental Determinants of Blood Pressure Regulation in Normal and Hypertensive Conditions

Cited by 31 publications

References 468 publications

Administration-Time-Dependent Effects of Spirapril on Ambulatory Blood Pressure in Uncomplicated Essential Hypertension

Administration-Time-Dependent Effects of Spirapril on Ambulatory Blood Pressure in Uncomplicated Essential Hypertension

Prognostic value of ambulatory blood pressure measurements for the diagnosis of hypertension in pregnancy

Optimal timing for antihypertensive dosing: focus on valsartan

Contact Info

Product

Resources

About