OPPORTUNITIES OF CHRONOTHERAPY USE IN TREATMENT OF ARTERIAL HYPERTENSION AND COMORBID DISORDERS

Cover Page

Cite item

Full Text

Abstract

Arterial hypertension (AH) chronotherapy includes using antihypertensive medications (AHM) in evenings that is especially rational in patients with disturbed daily rhythm of blood pressure (BP) changes (non-dipping, reverse dipping). Chronotherapy use results in increase of hypotensive therapy effect and normalization of nocturnal BP dipping as well as cardiovascular risk reduction. In large prospective studies (МАРЕС, n=3344, Hygia Chronotherapy Trial, n=19 084) intake of >1 medication in the evening resulted in significant additional decrease of all cardiovascular events by 61% and 45%, respectively. In chronotherapy evaluation for different AHM groups the best effect was seen in renin-angiotensin-aldosterone system antagonists (angiotensine transforming enzyme inhibitors, angiotensin II receptor blockers) and calcium antagonists. Chronotherapy advantages were shown in elderly patients, patients with resistant AH, and comorbid chronic renal disease and diabetes mellitus. According to randomized clinical studies results and metaanalyses in patients with AH and chronic renal disease intake of AHM in the evening resulted in normalization of 24-hour BP profile and achievement of renoprotective effect (proteinuria decrease, glomerular filtration rate increase), as well as in decrease of relative risk of cardiovascular outcomes almost by 70%. In МАРЕС study in patients with AH and diabetes mellitus evening intake of AHM also resulted in 24-hour BP profile normalization and significant decrease of risks by almost 70%. Apart from that, in patients without history of diabetes after chronotherapy use with evening intake of AHM apart from betel BP level control, three-fold decrease in diabetes mellitus incidence was observed (relative risk 0.43). Chronotherapy use in AH and comorbid disorders is an additional method of pharmacotherapy optimization that is safe for use in clinical practice.

About the authors

Marina V. Leonova

Interregional Public Organization "Russian Association of Clinical Pharmacologists"

Email: anti23@mail.ru
чл.-кор. РАЕН, д-р мед. наук, проф., клинический фармаколог, член МОО «Ассоциация клинических фармакологов России»

References

  1. Parati G, Stergiou G, O'Brien E et al; European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014; 32 (7): 1359-66. doi: 10.1097/HJH.0000000000000221
  2. Kario K, Shimada K. Risers and extreme-dippers of nocturnal blood pressure in hypertension: antihypertensive strategy for nocturnal blood pressure. Clin Exp Hypertens 2004; 26 (2): 177-89. doi: 10.1081/ceh-120028556
  3. Salles GF, Reboldi G, Fagard RH et al; ABC-H Investigators. Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis. Hypertension 2016; 67 (4): 693-700. doi: 10.1161/HYPERTENSIONAHA.115.06981
  4. Hermida RC, Smolensky MH. Chronotherapy of hypertension. Curr Opin Nephrol Hypertens 2004; 13: 501-5. doi: 10.1097/00041552-200409000-00004 ИНФОРМАЦИЯ ОБ АВТОРЕ / INFORMATION ABOUT THE AUTHOR
  5. Hermida RC, Ayala DE, Fernandez JR et al. Administration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. Chronobiol Int 2013; 30 (1-2): 280-314. doi: 10.3109/07420528.2012.709448
  6. Smolensky MH, Hermida RC, Ayala DE et al. Administration-time-dependent effects of blood pressure-lowering medications: basis for the chronotherapy of hypertension. Blood Press Monit 2010; 15 (4): 173-80. doi: 10.1097/MBP.0b013e32833c7308
  7. Hermida RC, Ayala DE, Mojdn A, Fernandez JR. Influence of circadian time of hypertension treatment on cardiovascular risk: Results of the MAPEC study. Chronobiol Int 2010; 27: 1629-51. doi: 10.3109/07420528.2010.510230
  8. Hermida RC, Ayala DE, Fernandez JR, Mojdn A. Sleep-time blood pressure: prognostic value and relevance as a therapeutic target for cardiovascular risk reduction. Chronobiol Int 2013; 30 (1-2): 68-86. doi: 10.3109/07420528.2012.702581
  9. Hermida RC, Ayala DE, Crespo JJ et al. Influence of age and hypertension treatment-time on ambulatory blood pressure in hypertensive patients. Chronobiol Int 2013; 30 (1-2): 176-91. doi: 10.3109/07420528.2012.701131
  10. Ayala DE, Hermida RC, Mojdn A, Fernandez JR. Cardiovascular risk of resistant hypertension: dependence on treatment-time regimen of blood pressure-lowering medications. Chronobiol Int 2013; 30 (1-2): 340-52. doi: 10.3109/07420528.2012.701455
  11. Hermida RC, Crespo JJ, Dominguez-Sardina M et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J 2019. doi: 10.1093/eur-heartj/ehz754 [Epub ahead of print]
  12. Agarwal R. Ambulatory blood pressure and cardiovascular events in chronic kidney disease. Semin Nephrol 2007; 27 (5): 538-43. doi: 10.1016/j.semnephrol.2007.07.001
  13. Fedecostante M, Spannella F, Cola G et al. Chronic kidney disease is characterized by "double trouble" higher pulse pressure plus night-time systolic blood pressure and more severe cardiac damage. PLoS One 2014; 9 (1): e86155. doi: 10.1371/journal.pone.0086155
  14. Koopman MG, Koomen GC, Krediet RT et al. Circadian rhythm of glomerular filtration rate in normal individuals. Clin Sci (Lond) 1989; 77 (1): 105-11. doi: 10.1042/cs0770105
  15. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in chronic kidney disease. J Am Soc Nephrol 2011; 22: 2313-21. doi: 10.1681/ASN.2011040361
  16. Crespo JJ, Pineiro L, Otero A et al; Hygia Project Investigators. Administration-time-dependent effects of hypertension treatment on ambulatory blood pressure in patients with chronic kidney disease. Chronobiol Int 2013; 30 (1-2): 159-75. doi: 10.3109/07420528.2012.701459
  17. Minutolo R, Gabbai FB, Borrelli S et al. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. Am J Kidney Dis 2007; 50 (6): 90817. doi: 10.1053/j.ajkd.2007.07.020
  18. Liu X, Liu X, Huang W et al. Evening -versus morning- dosing drug therapy for chronic kidney disease patients with hypertension: a systematic review. Kidney Blood Press Res 2014; 39 (5): 42740. doi: 10.1159/000368456
  19. Wang C, Ye Y, Liu C et al. Evening versus morning dosing regimen drug therapy for chronic kidney disease patients with hypertension in blood pressure patterns: a systematic review and meta-ana-lysis. Intern Med J 2017; 47 (8): 900-6. doi: 10.1007/s11255-016-1437-2
  20. Cachofeiro V, Goicochea M, de Vinuesa SG et al. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney Int 2008; 74 (Suppl. 111): S4-S9. doi: 10.1038/ki.2008.516
  21. Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet 2012; 380 (9841): 601-10. doi: 10.1016/S0140-6736(12)60987-8
  22. Palmas W, Pickering T, Teresi J et al. Nocturnal blood pressure elevation predicts progression of albuminuria in elderly people with type 2 diabetes. J Clin Hypertens (Greenwich) 2008; 10: 12-20. doi: 10.1111/j.1524-6175.2007.07170.X
  23. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of time of day of blood pressure-lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care 2011; 34: 1270-6. doi: 10.2337/dc11-0297
  24. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial. Diabetologia 2016; 59 (2): 255-65. doi: 10.1007/s00125-015-3749-7
  25. Moya A, Crespo JJ, Ayala DE et al; Hygia Project Investigators. Effects of time-of-day of hypertension treatment on ambulatory blood pressure and clinical characteristics of patients with type 2 diabetes. Chronobiol Int 2013; 30 (1-2): 116-31. doi: 10.3109/07420528.2012.702587
  26. Standards of medical care in diabetes - 2014. Diabetes Care 2014; 37 (Suppl. 1): S14-S80. doi: 10.2337/dc14-S014

Copyright (c) 2020 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies