Circadian variations in blood pressure in health and disease: implications for patient management

Chugh, Atul R.; Loughran, John; Slaughter, Mark S.

doi:10.2147/cpt.s15597

Cited by 2 publications

(1 citation statement)

References 117 publications

(99 reference statements)

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“…On the other hand, some patients have no pressure drop at night or who have a pressure drop below 10%; these patients are referred to as "non-dippers". More recently, the classification has been extended to include two further groups: "extreme-dippers" who have a nocturnal blood pressure drop of more than 20% and "rising/inverse dippers" in which systolic blood pressure is higher at night than during the day [69]. A schematic representation of blood pressure fluctuations in these categories is given in Figure 5.…”

Section: Models Of Circadian Blood Pressure Fluctuationsmentioning

confidence: 99%

Antihypertensives’ Rock around the Clock

Rahić

Tucak

Sirbubalo

et al. 2021

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Although homeostasis is a commonly accepted concept, there is incontrovertible evidence that biological processes and functions are variable and that variability occurs in cycles. In order to explain and understand dysregulation, which has not been embraced by homeostatic principles, the allostatic model has emerged as the first serious challenge to homeostasis, going beyond its homeostatic roots. Circadian rhythm is the predominant variation in the body, and it is a pattern according to which many physiological and pathological events occur. As there is strong experimental and clinical evidence that blood pressure fluctuations undergo circadian rhythm, there is equally strong evidence that targeted time therapy for hypertension provides a better outcome of the disease. The research has gone even further throughout the development and approval process for the use of pulsatile drug release systems, which can be considered as an option for an even more convenient dosage regimen of the medicines needed.

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Section: Models Of Circadian Blood Pressure Fluctuationsmentioning

confidence: 99%

Antihypertensives’ Rock around the Clock

Rahić

Tucak

Sirbubalo

et al. 2021

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Cardiovascular Adverse Effects of Phenylephrine Eyedrops

et al. 2015

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IMPORTANCE Topical phenylephrine hydrochloride is routinely administered with few safety precautions, but evidence regarding its systemic safety to date is controversial. As even short-term variations in 24-hour blood pressure (BP) and heart rate (HR) can adversely affect cardiovascular health, better evidence on phenylephrine's effects on HR and BP is required.OBJECTIVE To perform a meta-analysis of available evidence regarding cardiovascular adverse effects of topical phenylephrine.DATA SOURCES PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews and Clinical Trials were searched for relevant literature from January 1, 1970, to January 1, 2014, using a combination of the following search terms: topical, ocular, ophthalmic, phenylephrine, tropicamide, cardiovascular effect, side effect, blood pressure, heart rate, mydriatic, and eye drops. A total of 70 articles related to the topic were identified and all full texts were retrieved.STUDY SELECTION Randomized clinical trials reporting change in BP and HR for adults were included in this review. All studies reporting results for neonates or infants, not reporting standard deviations, or not specifying the time of measurement or the concentration of phenylephrine used were excluded.DATA EXTRACTION AND SYNTHESIS Data from randomized clinical trials that reported BP and/or HR as well as the time following administration of topical phenylephrine at which measurements were obtained by concentration of phenylephrine as a mean change and its standard deviation were extracted. Data were synthesized by concentration of phenylephrine and time of measurement following topical application using random-effects models with inverse variance weighting to account for heterogeneity across studies. MAIN OUTCOMES AND MEASURES Difference in BP and HR after topical administration of phenylephrine.RESULTS Eight RCTs with a total of 916 participants were included. Data were available for phenylephrine, 2.5%, at 20 to 30 minutes and 60 minutes or longer after administration, and neither BP nor HR changed at either time. Following application of phenylephrine, 10%, BP increased at 5 and 10 minutes (mean difference for both, +15 mm Hg; 95% CI, 11.94-18.54; P < .001) but decreased at 20 to 30 minutes and 60 minutes or longer with no changes detected against baseline. A mean increase in HR by 4.48 beats/min (95% CI, 1.09-7.88; P = .01) was present at 20 to 30 minutes following application of phenylephrine, 10%, and HR decreased by 60 minutes or longer with no changes detected compared with baseline.CONCLUSIONS AND RELEVANCE Phenylephrine, 2.5%, leads to no clinically relevant change in BP or HR, and the changes in BP and HR seen with phenylephrine, 10%, are short lived. Thus, phenylephrine, 2.5%, is safe to use in clinical routine.

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Circadian variations in blood pressure in health and disease: implications for patient management

Cited by 2 publications

References 117 publications

Antihypertensives’ Rock around the Clock

Antihypertensives’ Rock around the Clock

Cardiovascular Adverse Effects of Phenylephrine Eyedrops

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