Klinická farmakologie a farmacie – 2/2021

www.klinickafarmakologie.cz / Klin Farmakol Farm 2021; 35(2): 74–77 / KLINICKÁ FARMAKOLOGIE A FARMACIE 77 HLAVNÍ TÉMA Chronoterapia hypertenzie: večerná aplikácia antihypertenzív ako reálny determinant kardiovaskulárnej prognózy? relatívne homogénnej španielskej populácii kaukazskej rasy pod vedením tej istej skupiny investigátorov, čo bráni v extrapolácii výsled- kov na všeobecnú diverznú populáciu (15, 17). Záver Z vyššie uvedeného vyplýva, že chrono- terapia hypertenzie, ako ľahko implemento- vateľný terapeutický zásah so signifikantným KVS benefitom, nesie potenciál stať sa súčas- ťou odporúčaní pre manažment hyperten- zie. Bude však potrebné, aby výsledky štúdií MAPEC a Hygia Chronotherapy Trial boli po- tvrdené nezávislými výskumnými skupinami na rasovo a etnicky diverznej populácii pri zachovaní chronoterapeutického dizajnu: mo- nitorovanie cirkadiánnych zmien TK pomocou 24h alebo 48h ABPM a simultánne sledovanie fyzickej aktivity aktigrafiou alebo pomocou diára na stanovenie časového intervalu dennej aktivity a nočného spánku (22). Od publikovania výsledkov MAPEC v roku 2010 sa iniciovalo niekoľko štúdií zameraných na chronoterapiu hypertenzie, s dominan- ciou anglickej štúdie TIME (angl. Treatment In Morning versus Evening) (23), kanadskej štúdie BedMed (ClinicalTrials.gov ID: NCT02990663) a americkej štúdie BPMedTime (angl. Blood Pressure Medication Timing Study) (24). Ani jedna štúdia z uvedených však nespĺňa všetky vyššie opísané propozície potrebné pre legi- tímne potvrdenie výsledkov MAPEC a Hygia Chronotherapy Trial. Navyše štúdia BPMedTime bola predčasne ukončená po tom, čo Ústav bioetiky NIH (angl. National Institutes of Health) poukázal na dôležité etické nedostatky a spo- chybnil jej prínos na základe dostatku existu- júcich informácií potvrdzujúcich KVS benefit chronoterapie hypertenzie (25). Okrem TK aj hodnoty srdcovej frekven- cie (SF) podliehajú denným rytmom, a tak prekonávajú fyziologické zmeny počas 24 hodín. Porušený denný rytmus SF pri hy- pertenzii (zvýšená nočná SF a nedostatočný nočný dipping SF) sa taktiež spája s vyšším výskytom závažných KVS udalostí a mô- že prispieť k predikcii KVS rizika (26, 27). Predpokladá sa, že selektívnym znížením nočnej SF (a podporou dippingu SF) by sa dosiahol aditívny KVS benefit pri manaž- mente hypertenzie (28, 29). LITERATÚRA 1. Thosar SS, Butler MP, Shea SA. Role of the circadian system in cardiovascular disease. J Clin Invest. 2018; 128(6): 2157–2167. 2. Simko F, Paulis L. Chronotherapy beyond blood pressure reduction? 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