Effect of bedtime administration of blood-pressure lowering agents on ambulatory blood pressure monitoring results: A meta-analysis

Abstract

SBP/DBP, (Cardiol J 2016; 23, 4: 473-481)

Some features of blood pressure variability in patients with arterial hypertension in various modes of antihypertensive therapy

“…Despite the growing evidence that the evening taking of antihypertensive drugs helps to normalize the daily BP profile [18,19], our study did not confirm this hypothesis.…”

Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association

“…Alteration of the dosing times (eg, to include a nocturnal dose) or using divided doses of drugs with half-lives of <12 to 15 hours may also improve BP control even when the drug theoretically has a pharmacodynamic effect of up to 24 hours in duration. 387,388 Dosing at night of certain agents, for example, guanfacine, also helps reduce adverse effects such as drowsiness and may aid in sleeping.…”

Guidelines for the design and conduct of human clinical trials on ingestion-time differences – chronopharmacology and chronotherapy – of hypertension medications

“…More than 150 published human trials describe the differential effects on blood pressure (BP) control, biomarkers of elevated BP-induced injury to blood vessels, heart, and kidney tissue, and cardiovascular disease (CVD) morbidity and mortality exerted by prescription single and combination hypertension medications when ingested in the morning or upon-waking versus evening or at bedtime (Bowles et al 2018;De Giorgi et al 2013;Hermida et al 2016Hermida et al , 2020bHermida et al , 2020cLiu et al 2014;Schillaci et al 2015;Stranges et al 2015;Sun et al 2016;Zhao et al 2011). In-depth review of thesesome conceptualized as "time-of-day" rather than appropriate circadian-time -published trials reveal diverse and often suboptimal protocols.…”

“…Current hypertension guidelines fail to make a recommendation on the time of when-to-treat (Chiang et al 2015;National Institute for Health and Clinical Excellence, 2019;Piper et al 2015;Rabi et al 2020;Umemura et al 2019;Unger et al 2020;Wang 2015;Whelton et al 2018;Williams et al 2018), despite the extensive information derived from past prospective, randomized, chronopharmacology and chronotherapy trials on the advantages and safety of the bedtime hypertension treatment strategy (Bowles et al 2018;De Giorgi et al 2013;Hermida et al 2016Hermida et al , 2020bHermida et al , 2020cLiu et al 2014;Schillaci et al 2015;Stranges et al 2015;Sun et al 2016;Zhao et al 2011). Thus, those hypertension guidelines disregard the relevance of circadian rhythms that: (i) regulate BP level and 24 h patterning as the basis for making the differential diagnosis of normotension versus hypertension and (ii) affect the PK (absorption, distribution, metabolism, and elimination) and PD (efficacy and safety) of hypertension medications as the basis for deciding the optimum time of when-to-treat.…”

“…Statistically and clinically significant ingestion-time (with reference to the circadian staging of biological rhythms) differences in the PD, both in regards to the efficacy and safety of hypertension medications, are clearly evident by observed disparities in the therapeutic modulation of the BP 24 h pattern -especially those features identified with highest associated CVD risk, namely the asleep BP mean and sleep-time relative BP decline -and occurrence of adverse effects (Bowles et al 2018;De Giorgi et al 2013;Hermida et al 2016Hermida et al , 2020bHermida et al , 2020cLiu et al 2014;Schillaci et al 2015;Stranges et al 2015;Sun et al 2016;Zhao et al 2011). Such treatment-time-dependent (properly conceptualized as circadian rhythm-time-dependent) differences in the PD of hypertension medications result not only from those circadian rhythms that influence PK but also from various other circadian rhythms that: (i) affect circulating free-fraction concentration, cell/tissue receptor number/conformation and second messengers/ signaling pathways of drug-targeted sites, such as blood vessels, heart and renal tissue plus (ii) comprise mechanisms of the 24 h BP pattern, especially the ANS and RAAS (Angeli et al 1992;Fabbian et al 2013;Hermida et al 2007;Portaluppi et al 2012;Smolensky et al 2007Smolensky et al , 2017Sothern et al 1995).…”