title: Chronotherapeutics of conventional blood pressure-lowering medications: simple, low-cost means of improving management and treatment outcomes of hypertensive-related disorders.
abstract: Correlation between blood pressure (BP) target organ damage, cardiovascular risk, and long-term prognosis is greater for ambulatory monitored (ABPM) than daytime in-clinic measurements. Additionally, consistent evidence of numerous studies substantiates the ABPM-determined asleep BP mean is an independent and stronger predictor of risk and incidence of end-organ injury and cardiovascular events than the awake or 24-h means. Hence, cost-effective control of sleep-time BP is of great clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of six different classes and their combinations significantly impacts beneficial and/or adverse effects. For example, because the high-amplitude circadian rhythm of the renin-angiotensin-aldosterone system activates during nighttime sleep, bedtime versus morning ingestion of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers better controls the asleep than awake BP means, with additional benefit independent of terminal half-life of converting the 24-h BP profile into more normal dipper patterning. Recent findings authenticate therapeutic reduction of sleep-time BP, best achieved when the full daily dose of ≥1 hypertension medications is routinely ingested at bedtime, is the most significant independent predictor of lowered cardiovascular and cerebrovascular risk.
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, 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: José R
authors.initials: JR
authors.lastname: Fernández
authors.forename: Artemio
authors.initials: A
authors.lastname: Mojón
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Crespo
authors.forename: María T
authors.initials: MT
authors.lastname: Ríos
authors.forename: Ana
authors.initials: A
authors.lastname: Moyá
authors.forename: Francesco
authors.initials: F
authors.lastname: Portaluppi
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D055870:Drug Chronotherapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D012890:Sleep / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents