Administration-Time Differences in Effects of Hypertension Medications on Ambulatory Blood Pressure Regulation

摘要: Specific features of the 24-h blood pressure (BP) pattern are linked to progressive injury target tissues and risk cardiovascular disease (CVD) events. Several studies have consistently shown an association between blunted asleep BP decline fatal nonfatal CVD Thus, there is growing focus on ways properly control during nighttime sleep as well daytime activity. One strategy, termed chronotherapy, entails timing hypertension medications endogenous circadian rhythm determinants pattern. Significant clinically meaningful treatment-time differences in beneficial and/or adverse effects at least six different classes medications, their combinations, now known. Generally, calcium channel blockers (CCBs) more effective with bedtime than morning dosing, for dihydropyridine derivatives dosing significantly reduces peripheral edema. The renin-angiotensin-aldosterone system highly rhythmic activates sleep. Accordingly, evening/bedtime ingestion angiotensin-converting enzyme inhibitors (ACEIs) benazepril, captopril, enalapril, lisinopril, perindopril, quinapril, ramipril, spirapril, trandolapril, zofenopril exerts marked effect awake systolic (SBP) diastolic (DBP) means. Likewise, bedtime, comparison morning, schedule angiotensin-II receptor (ARBs irbesartan, olmesartan, telmisartan, valsartan greater therapeutic BP, plus significant increase sleep-time relative decline, additional benefit, independent drug terminal half-life, converting profile into a normal dipping This case also versus upon-awakening regimen combination ARB-CCB, ACEI-CCB, ARB-diuretic medications. chronotherapy conventional constitutes new cost-effective strategy enhancing SBP DBP levels, normalizing status patterning, potentially reducing events end-organ injury, example, vessels heart, brain, kidney, retina.