title: Sleep-time ambulatory blood pressure as a novel therapeutic target for cardiovascular risk reduction.
abstract: Diagnosis of hypertension and clinical decisions regarding its treatment are typically based upon daytime clinic blood pressure (BP) measurements, occasionally supplemented by wake-time patient self-assessment. Yet, correlation between BP level and target organ damage, cardiovascular disease (CVD) risk, and long-term prognosis is higher for ambulatory BP monitoring (ABPM) measurements. Numerous studies consistently reveal CVD events are better predicted by the asleep than awake or 24 h BP means. In addition, when the asleep BP mean is adjusted by the awake mean, only the former is a significant independent predictor of outcome. Endogenous circadian rhythms explain statistically and clinically significant ingestion time differences in efficacy, duration of action, safety and/or effects on the daily BP pattern of most hypertension medications and their combinations. Bedtime versus morning-time ingestion of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, independent of drug terminal half-life, both better reduces asleep BP and normalizes the daily BP profile into a more normal dipper pattern. The recently completed prospective outcome MAPEC Study verifies therapeutic restoration of the normal sleep-time BP decline, a novel therapeutic goal most effectively achieved by ingestion of the entire daily dose of ⩾ 1 conventional hypertension medications at bedtime, best decreases CVD morbidity and mortality. Our findings indicate around-the-clock ABPM is a clinical necessity to accurately detect abnormal sleep-time BP and assess CVD risk, and that hypertension ought to be managed by a bedtime therapeutic strategy, preferably one including medication that antagonizes the activities and actions of the renin-angiotensin-aldosterone system.
authors: Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo, Spain.
authors: R C
authors: RC
authors: Hermida
authors: Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo, Spain.
authors: D E
authors: DE
authors: Ayala
authors: Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo, Spain.
authors: A
authors: A
authors: Mojón
authors: Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX, USA.
authors: M H
authors: MH
authors: Smolensky
authors: 1] Hypertension Center, University Hospital S. Anna, Ferrara, Italy [2] Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
authors: F
authors: F
authors: Portaluppi
authors: Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, E.I. Telecomunicación, Campus Universitario, Vigo, Spain.
authors: J R
authors: JR
authors: Fernández
mesh_terms: D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006339:Heart Rate; D006801:Humans; D011379:Prognosis; D012084:Renin-Angiotensin System / Q000187:drug effects; D012306:Risk; D012890:Sleep / Q000502:physiology*