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Strategies against high blood pressure in the early morning
1Department of Pharmacology, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.
Insights
The morning surge in blood pressure, linked to cardiovascular events, can be managed through pharmacodynamic and pharmacokinetic approaches. Further research is needed to confirm if these treatments improve long-term outcomes for hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Chronobiology
Background:
- Vascular events like myocardial infarction and cerebrovascular disease peak in the early morning.
- This pattern is associated with increased blood pressure, sympathetic activity, and hypercoagulability.
- The morning blood pressure surge is a potential factor in hypertensive complications.
Purpose of the Study:
- To explore strategies for managing the morning blood pressure surge.
- To review pharmacodynamic and pharmacokinetic approaches to blood pressure control.
Main Methods:
- Examined pharmacodynamic strategies, focusing on adrenergic alpha-blocking agents.
- Investigated pharmacokinetic approaches, emphasizing sustained drug concentrations during critical morning hours.
- Reviewed studies on long-acting agents, regimen adjustments, and chronobiological systems.
Main Results:
- Studies show successful results in lowering morning blood pressure using various interventions.
- Pharmacodynamic approaches often involve alpha-blockers.
- Pharmacokinetic strategies focus on maintaining therapeutic drug levels in the early morning.
Conclusions:
- Managing the morning blood pressure surge is crucial for hypertensive patients.
- Both pharmacodynamic and pharmacokinetic strategies show promise in controlling morning blood pressure.
- Long-term outcome studies are necessary to validate the efficacy of these treatments.
Abstract:
Acute myocardial infarction and cerebrovascular disease reportedly show peak onset in the early morning, when blood pressure increases. The increase of blood pressure, or morning surge, may result from increased sympathetic activity reactive to arousal. The circadian pattern of vascular events is considered to be related to the morning surge in blood pressure, sympathetic activity, and hypercoagulability. Although there is no direct evidence indicating a causal relationship between the morning surge in blood pressure and vascular complications, it may be postulated that morning blood pressure surge is a factor which affects hypertensive complications. There may be two possible approaches to morning blood pressure surge; the pharmacodynamic and pharmacokinetic approach. On the basis of pharmacodynamics, drugs with adrenergic alpha-blocking actions are usually selected. From a pharmacokinetic view, it is essential to maintain blood concentration of a drug at the critical early morning period. On this point, use of long acting agents, changes in drug regimen and the development of a chronobiological system has been studied, with many studies reporting successful results in lowering morning blood pressure. Further study whether such kinds of treatments improve long term outcomes in hypertensive patients are desired.
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