Does Timing of Antihypertensive Medication Dosing Matter?
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HYPERTENSION (DS GELLER AND DL COHEN, SECTION EDITORS)
Does Timing of Antihypertensive Medication Dosing Matter? Ramón C. Hermida 1,2 & Ramón G. Hermida-Ayala 3 & Michael H. Smolensky 2 & Artemio Mojón 1 & Juan J. Crespo 1,4 & Alfonso Otero 5 & María T. Ríos 1,4 & Manuel Domínguez-Sardiña 4 & José R. Fernández 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Current hypertension guidelines do not provide recommendation on when-to-treat. Herein, we review the current evidence on ingestion-time differences of hypertension medications in blood pressure (BP)–lowering effects and prevention of cardiovascular disease (CVD) events. Recent Findings The vast (81.6%) majority of the 136 published short-term treatment-time trials document benefits, including enhanced reduction of asleep BP and increased sleep-time relative BP decline (dipping), when hypertension medications and their combinations are ingested before sleep rather than upon waking. Long-term outcome trials further document bedtime hypertension therapy markedly reduces risk of major CVD events. The inability of the very small 18.4% of the published trials to substantiate treatment-time difference in effects is mostly explained by deficiencies of study design and conduct. Summary Our comprehensive review of the published literature reveals no single study has reported better benefits of the still conventional, yet scientifically unjustified, morning than bedtime hypertension treatment scheme. Keywords Ambulatory blood pressure monitoring . Asleep blood pressure . Bedtime hypertension chronotherapy . Cardiovascular risk reduction . Diagnosis of hypertension . Hygia Chronotherapy Trial
This article is part of the Topical Collection on Hypertension * Ramón C. Hermida [email protected] Ramón G. Hermida-Ayala [email protected]
José R. Fernández [email protected] 1
Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic);, University of Vigo, 36310 Vigo, Spain
2
Department of Biomedical Engineering, Cockrell School of Engineering,, The University of Texas at Austin, Austin, TX 78712-0238, USA
Juan J. Crespo [email protected]
3
Circadian Ambulatory Technology & Diagnostics (CAT&D), 15703 Santiago de Compostela, Spain
Alfonso Otero [email protected]
4
Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), 36214 Vigo, Spain
5
Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS), 32005 Ourense, Spain
Michael H. Smolensky [email protected] Artemio Mojón [email protected]
María T. Ríos [email protected] Manuel Domínguez-Sardiña [email protected]
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Introduction The fields of medical chronobiology (study of biological rhythms and medicine), chronopharmacology (influence of medication dosing-time rel
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