title: Chronotherapy improves blood pressure control and reduces vascular risk in CKD.
abstract: In patients with chronic kidney disease (CKD), the prevalence of increased blood pressure during sleep and blunted sleep-time-relative blood pressure decline (a nondipper pattern) is very high and increases substantially with disease severity. Elevated blood pressure during sleep is the major criterion for the diagnoses of hypertension and inadequate therapeutic ambulatory blood pressure control in these patients. Substantial, clinically meaningful ingestion-time-dependent differences in the safety, efficacy, duration of action and/or effects on the 24 h blood pressure pattern of six different classes of hypertension medications and their combinations have been substantiated. For example, bedtime ingestion of angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers is more effective than morning ingestion in reducing blood pressure during sleep and converting the 24 h blood pressure profile into a dipper pattern. We have identified a progressive reduction in blood pressure during sleep--a novel therapeutic target best achieved by ingestion of one or more hypertension medications at bedtime--as the most significant predictor of decreased cardiovascular risk in patients with and without CKD. Recent findings suggest that in patients with CKD, ambulatory blood pressure monitoring should be used for the diagnosis of hypertension and assessment of cardiovascular disease risk, and that therapeutic strategies given at bedtime rather than on awakening are preferable for the management of hypertension.
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo 36310, Spain. rhermida@uvigo.es
authors.forename: Ramón C
authors.initials: RC
authors.lastname: Hermida
authors.forename: Diana E
authors.initials: DE
authors.lastname: Ayala
authors.forename: Michael H
authors.initials: MH
authors.lastname: Smolensky
authors.forename: Artemio
authors.initials: A
authors.lastname: Mojón
authors.forename: José R
authors.initials: JR
authors.lastname: Fernández
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Crespo
authors.forename: Ana
authors.initials: A
authors.lastname: Moyá
authors.forename: María T
authors.initials: MT
authors.lastname: Ríos
authors.forename: Francesco
authors.initials: F
authors.lastname: Portaluppi
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D019454:Chronotherapy / Q000379:methods*; D002940:Circadian Rhythm / Q000502:physiology; D006801:Humans; D006977:Hypertension, Renal / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents