Klin Farmakol Farm. 2021;35(2):74-77 | DOI: 10.36290/far.2021.012

Hypertension chronotherapy: does dosing antihypertensive medication at bedtime determine cardiovascular prognosis?

Tomáš Baka^1*, Peter Stanko^1*, Fedor Šimko^{1, 2, 3}

¹ Ústav patologickej fyziológie, Lekárska fakulta, Univerzita Komenského v Bratislave

² III. interná klinika, Lekárska fakulta a Univerzitná nemocnica, Univerzita Komenského v Bratislave

³ Ústav experimentálnej endokrinológie, Biomedicínske centrum, Slovenská akadémia vied v Bratislave

^* Tomáš Baka a Peter Stanko prispeli k tejto práci rovnakou mierou, a preto zdieľajú prvoautorstvo.

Arterial blood pressure (BP) undergoes variable changes over 24 hours conforming to physiological daily rhythms. Disruption of the natural BP circadian rhythm is associated with worsened cardiovascular disease (CVD) prognosis. Increased nocturnal BP or at least insufficient BP decline at night, i.e. non-dipping, may be associated with morphological and functional alterations of peripheral organs and even with a higher incidence of major CVD events. Hypertension chronotherapy means the application of antihypertensive treatment in order to maintain the daily BP variability in terms of reduced nocturnal BP (thus also maintaining sufficient nocturnal BP dipping), which could bring an additive benefit to the usual morning administration of antihypertensive medications. Taking into account the circadian rhythms in the pharmacokinetics and pharmacodynamics of antihypertensives, the reduction of nocturnal BP can be achieved by administering at least part of the applied antihypertensive medications at bedtime. This commentary analyzes the benefits, pitfalls and perspectives of hypertension chronotherapy.

Keywords: hypertension, chronotherapy, circadian rhythm, cardiovascular prognosis, MAPEC, Hygia Chronotherapy Trial.

Published: July 6, 2021  Show citation