Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study.

摘要: Clinical studies have documented morning-evening, administration-time differences of several different classes hypertension medications in blood pressure (BP)-lowering efficacy, duration action, safety profile, and/or effects on the circadian BP pattern. In spite these published findings, most hypertensive subjects, including those under combination therapy, are instructed by their physicians and pharmacists to ingest all BP-lowering morning. The potential differential reduction cardiovascular (CVD) morbidity mortality risk a bedtime versus upon-awakening treatment schedule has never been evaluated prospectively. prospective MAPEC study was specifically designed test hypothesis that chronotherapy with ≥1 exerts better control CVD than conventional i.e., ingested A total 2156 1044 men/1112 women, 55.6± 13.6 (mean± SD) yrs age, were randomized prescribed upon awakening or them at bedtime. At baseline, measured 20-min intervals from 07:00 23:00 h 30-min night for 48 h. Physical activity simultaneously monitored every min wrist actigraphy accurately determine beginning end daytime nocturnal sleep. Identical assessment scheduled annually more frequently (quarterly) if adjustment required. Despite lack ambulatory between groups subjects ingesting medication showed last available evaluation significantly lower mean sleep-time BP, higher relative decline, reduced prevalence non-dipping (34% 62%; p < .001), controlled (62% 53%; .001). After median follow-up 5.6 yrs,