[Consequences of circadian variability for the treatment of ischemic heart disease].
The incidence of ischemic cardiac events is highest in the early morning hours (symptomatic and asymptomatic cardiac ischemia, myocardial infarction, and sudden death). Quantitatively, however, most of them occur during the rest of the day; therefore, an ideal therapy should be established in the early morning hours and be efficient all day long. We recommend that nitrates should be taken as early as possible after a dose-is-free interval during the night. Patients taking beta-blockers do not show a circadian rhythm of the incidence of ischemic cardiac events. Compliance can be improved with the never long-acting agents. Therapy should be tailored individually for each patient. It is not yet known whether calcium blockers influence the circadian rhythm. The efficacy of the never preparations is comparable to the older ones. Aspirin can be taken at any time of the day because of its long duration of action.
Herren
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T
Centre de cardiologie, Hôpital cantonal universitaire, Genève Medizinische Universitätsklinik, Inselspital, Bern.
Urban
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P
Rutishauser
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W
D000787:Angina Pectoris / Q000503:physiopathology; D000925:Anticoagulants / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002940:Circadian Rhythm / Q000187:drug effects*; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
D000925:Anticoagulants; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors
Konsequenzen der zirkadianen Variabilität für Behandlung der ischämischen Herzkrankheit.