<b>Bedtime Administration of Cilnidipine Controls Morning Hypertension</b>

Abstract

SUMMARYMorning blood pressure (BP) level plays an important role in the incidence of cardiovascular disease. Recently, Kario, et al proposed the usefulness of ME difference (morning minus evening systolic BP) and ME average (average of morning and evening systolic BP) for the evaluation of antihypertensive treatment. Cilnidipine is a novel calcium channel blocker (CCB) that exerts inhibitory actions not only on L-type but also on N-type calcium channels. We investigated the effect of bedtime administration of cilnidipine (10 mg) in addition to the antihypertensive treatment for uncontrolled morning hypertension. Twenty-three hypertensive outpatients (13 males and 10 females; mean age, 66.9 years) with stable antihypertensive medication and uncontrolled morning BP were studied using self-measured BP monitoring in the morning and evening. Morning SBP (P < 0.001) and DBP (P < 0.001) decreased significantly from 150.2 ± 8.7 and 87.8 ± 9.3 to 132.7 ± 7.4 and 77.5 ± 8.5 mmHg, respectively, after the addition of cilnidipine. Morning heart rate did not change (63.3 ± 7.0 to 64.1 ± 9.4). The evening SBP, but not DBP, decreased significantly after treatment. Both the ME average (P < 0.001) and ME difference (P < 0.01) significantly decreased from 143.0 ± 9.2 and 14.3 ± 12.4 to 131.3 ± 7.2 and 2.8 ± 9.2 mmHg after treatment, respectively. The microalbuminuria decreased from 39.6 ± 13.2 to 27.3 ± 8.4 mg/g Cr. In conclusion, L-/N-type CCB cilnidipine may be useful for patients with uncontrollable morning hypertension by reducing both ME average and ME difference. (Int Heart J 2007; 48: 597-603) Key words: L-/N-type calcium channel blocker, Morning hypertension, Microalbuminuria CARDIOVASCULAR events occur most frequently in the morning 1,2) especially within 3 hours after waking.3) An elevated morning blood pressure (BP) level has been associated with target organ damage: left ventricular hypertrophy 4) and microalbuminuria.5) Recent reports demonstrated that morning hypertension measured either by ambulatory BP monitoring (ABPM) 6) or by self-measured BP From the

Wake-Up Stroke and Stroke of Unknown Onset: A Critical Review

“…It is speculated that the blood pressure leads to an increase in the likelihood of the rupture of a fragile atherosclerotic plaque. Timing the administration of anti-hypertensive medication in the evening has been proposed as strategy to circumvent the early-morning rise (16). A morning increase in platelet aggregation is mainly seen on arising and standing, and is probably due to an increase in catecholamine levels, platelet count, and hemo-concentration in the morning (14).…”

Changes in Home Versus Clinic Blood Pressure With Antihypertensive Treatments

“…We included 2 articles in which home BPs were measured only in the morning 31, 36 (the morning home BPs were used as the average home BPs in these studies) and one article where BP was measured in the morning, at noon, and in the evening. 16 We included some articles in which the method of clinic BP measurements was not clearly described, 15, 19, 24, 30, 31, 33, 35-37 and/or in which clinic BP was measured only once per clinic visit, 31 but we repeated our analyses excluding these articles. Rater differences in the selection of articles were discussed, and the last author (TGP) resolved any remaining discrepancies concerning article eligibility.…”

“…15, 19, 24, 30, 31, 33, 35-37 The exclusion criteria of the 9 articles were as follows: 1) the technique and/or device of clinic BP measurements were not written, 2) the clinic BP was measured only once, and 3) the clinic BP was not measured by physicians or nurses. There were 13 articles in which home BP data were described separately for the morning and evening BP.…”

“…12-15, 18, 20, 23, 25, 30, 37, 38, 40, 41 We also evaluated the changes in clinic, morning, and evening BP depending on whether the antihypertensive medication was taken in the morning 12-15, 18, 20, 23, 25, 30, 41 or in the evening. 12, 37, 38, 40 The effects of different antihypertensive drug classes on the changes in clinic and home BP (using morning dosing) were evaluated for calcium channel blockers (6 studies), 12, 16, 17, 25, 35, 37 angiotensin converting enzyme inhibitors (5 studies), 13, 14, 18, 21, 22 and angiotensin II receptor blockers (7 studies). 18, 20-22, 24, 33, 41 Finally, we were able to compare the reductions of home BP with those of 24-hr BP in 7 articles 18, 20, 22, 25, 26, 32, 39 , and with daytime BP and nighttime BP in 5 articles.…”

Effect of Switching from Cilnidipine to Azelnidipine on Cardiac Sympathetic Nerve Function in Patients with Heart Failure Preserved Ejection Fraction

“…19) On the other hand, cilnidipine has renal protective effects by dilating the import and export artery and improves early morning HT. 20,21) It is necessary to give considerations on the above points when making a decision for medications. 123 I-MIBG cardiac-scintigraphy and cardiac sympathetic nerve activity:…”