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Chronopharmacologic considerations when treating the patient with hypertension: a review
1Department of Pharmacy Practice, University of Minnesota College of Pharmacy, Minneapolis 55455, USA.
Insights
Cardiovascular disease exacerbations show daily rhythms, impacting medication effectiveness. Understanding this chronobiology with 24-hour ambulatory blood pressure monitoring aids in developing optimized, timed treatment strategies.
Area of Science:
- Cardiovascular Medicine
- Chronobiology
- Pharmacology
Background:
- Circadian variations in cardiovascular disease exacerbations are recognized.
- Physiological basis for cardiac disease chronobiology exists.
- Chronobiology influences the efficacy of cardiac disease management agents.
Purpose of the Study:
- To review studies on antihypertensive medications using 24-hour ambulatory blood pressure monitoring (ABPM).
- To increase awareness of chronobiology in cardiovascular disease.
- To explore implications for designing chronotherapeutic regimens.
Main Methods:
- Review of studies evaluating antihypertensive medications.
- Utilizing data from 24-hour ambulatory blood pressure monitoring (ABPM).
- Analysis of the interplay between chronobiologic rhythms and drug response.
Main Results:
- 24-hour ABPM advances understanding of chronobiology and drug response.
- Studies demonstrate the pharmacodynamic response to antihypertensive medications.
- The review synthesizes findings on medication efficacy in relation to circadian rhythms.
Conclusions:
- Circadian variation in cardiovascular disease exacerbations is clinically relevant.
- Chronobiology provides a basis for evaluating cardiac disease management agents.
- Awareness of chronobiology can inform the design of effective chronotherapeutic regimens.
Abstract:
Recognition of the existence of circadian variation in exacerbation of cardiovascular disease may have relevance to clinical use of cardioactive agents. Physiologic rational for the chronobiology of cardiac disease exists and can provide a basis on which to examine the efficacy of agents to manage cardiac disease. The use of 24-hour ambulatory blood pressure monitoring (ABPM) devices have advanced our ability to describe the interplay of chronobiologic rhythms and pharmacodynamic response to antihypertensive medications. This review summarizes the studies evaluating the use of various antihypertensive medications in the context of using 24-hour blood pressure monitoring devices. The studies are described in an attempt to increase awareness of chronobiology and potential implications of designing chronotherapeutic regimens.