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Treatment of hypertension with chronotherapy: is it time of drug administration?
Paul M Stranges1, Amy M Drew2, Patricia Rafferty3
1St Louis College of Pharmacy, MO, USA Barnes-Jewish Hospital Department of Pharmacy, St Louis, MO, USA.
Insights
Taking antihypertensive medications at bedtime, known as chronotherapy, can help normalize blood pressure patterns and reduce cardiovascular disease risk. Careful patient and drug selection is crucial for effective hypertension management.
Area of Science:
- Cardiology
- Pharmacology
- Chronobiology
Background:
- Hypertension management often involves daily medication schedules.
- Circadian rhythms significantly influence blood pressure and cardiovascular events.
- Optimizing antihypertensive dosing timing may improve patient outcomes.
Purpose of the Study:
- To review evidence supporting bedtime dosing of antihypertensives.
- To assess the potential for cardiovascular risk reduction with chronotherapy.
- To evaluate the impact of evening administration on blood pressure patterns.
Main Methods:
- Comprehensive literature search of PubMed, EMBASE, and Cochrane databases (1990-2014).
- Inclusion of prospective studies on cardiovascular outcomes or comparative antihypertensive administration times.
- Keywords included hypertension, chronotherapy, and drug administration schedules.
Main Results:
- Bedtime antihypertensive dosing normalizes circadian blood pressure patterns compared to morning dosing.
- Evening administration is associated with reduced cardiovascular morbidity and mortality in hypertensive individuals.
- Evidence is strongest for renin-angiotensin-aldosterone system inhibitors; further research is needed for other drug classes.
Conclusions:
- Chronotherapy shows promise for cost-effective cardiovascular risk reduction in hypertension.
- Current evidence suggests careful patient and antihypertensive selection is necessary for chronotherapy.
- Further investigation is required to establish definitive cardiovascular outcome benefits of chronotherapy.
Objective:
To review evidence for dosing antihypertensives at bedtime and possible cardiovascular risk reduction.
Data Sources:
A PubMed, EMBASE, and Cochrane Controlled Trials database literature search (1990-September 2014) limited to human subjects was performed using the search terms hypertension, chronotherapy, ambulatory blood pressure, morning administration, evening administration, and antihypertensives. Additional references were identified from literature citations.
Study Selection:
All prospective studies assessing cardiovascular outcomes or comparing morning to evening administration of antihypertensives were selected.
Data Synthesis:
Compared with morning administration, dosing one or more antihypertensive medications at bedtime helps induce a normal circadian blood pressure pattern and reduces the risk of cardiovascular disease morbidity and mortality in individuals with hypertension. Similar results have been reported in high-risk individuals with diabetes, chronic kidney disease, and resistant hypertension. A lack of diversity among studied populations and reliance on subgroup analyses are among the limitations of these data. All antihypertensive medications have not been studied in chronotherapy and do not uniformly achieve desired results. The most substantial evidence exists for medications affecting the renin-angiotensin-aldosterone system.
Conclusions:
Despite growing evidence and promise as a cost-effective strategy for reducing cardiovascular risk, chronotherapy is not uniformly recommended in the treatment of hypertension. Careful selection of patients and antihypertensives for chronotherapy is required. Further investigation is needed to evaluate the definitive impact of chronotherapy on cardiovascular outcomes.
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