Abstract:
:Appreciation of chronotherapy in hypertension continues to lag, despite clear demonstrations by many studies of (i) clinically relevant dosing-time differences of the beneficial and adverse effects of most blood pressure (BP) medications and (ii) significant association between reduced sleep-time BP decline of non-dippers and their heightened risk of cardiovascular disease (CVD). The Syst-Eur and HOPE outcome trials showed evening administration of nitrendipine and ramipril in these respective studies impacts sleep-time BP, converting the 24-h BP pattern to a more dipper one and in the HOPE study decreasing CVD risk. The CONVINCE study intended to compare BP control and CVD protection afforded by conventional β-blocker and diuretic medications versus a special drug-delivery verapamil formulation as a bedtime hypertension chronotherapy; however, the trial was terminated prematurely, not based on inadequate performance of the chronotherapy but on a corporate business decision. The just completed MAPEC study is the first trial specifically designed to prospectively test the hypothesis that bedtime administration of ≥1 conventional medications exerts better BP control and CVD risk reduction than the traditional approach of scheduling all medications in the morning. The results of this 5.6-yr median follow-up study establish that bedtime chronotherapy more effectively improves BP control, better decreases prevalence of non-dipping, and, most importantly, best reduces CVD morbidity and mortality. This chronotherapeutic approach to hypertension is justified by the fact that BP is usually lowest at night as is sodium excretion, but when sodium intake is excessive or its daytime excretion hampered, nocturnal BP is adjusted higher, to a level required for compensation overnight, via the pressure/natriuresis mechanism, resulting in non-dipping 24-h BP patterning. In diurnally active persons, the entire circadian BP pattern may be reset to a lower mean level and to a "more normal" day-night variation, simply by enhancing natriuresis during the night-the time-of-day when it can be most effective. A modification as simple and inexpensive as switching ≥1 hypertension medications from morning to evening may be all that is needed to normalize nighttime BP, exerting an effect exactly like sodium restriction. Current clinical concepts such as "normotensive non-dipper" (with higher CVD risk than a hypertensive dipper), broad recommendation of pharmacotherapy with exclusively high "smoothness index" medications (without attention to individual patient needs defined by the features of the 24-h BP pattern), and reliance upon static daytime diagnostic BP thresholds based solely on single office cuff assessment necessitate urgent reconsideration.
journal_name
Chronobiol Intjournal_title
Chronobiology internationalauthors
Portaluppi F,Smolensky MHdoi
10.3109/07420528.2010.510788subject
Has Abstractpub_date
2010-09-01 00:00:00pages
1652-67issue
8eissn
0742-0528issn
1525-6073journal_volume
27pub_type
杂志文章abstract::In mammals, non-visual responses to light involve intrinsically photosensitive melanopsin-expressing retinal ganglion cells (ipRGCs) that receive synaptic inputs from rod and cone photoreceptors. Several studies have shown that cones also play a role in light entrainment, photic responses of the suprachiasmatic nucleu...
journal_title:Chronobiology international
pub_type: 杂志文章
doi:10.3109/07420521003695704
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abstract::Physiological and biomechanical constraints as well as their fluctuations throughout the day must be considered when studying determinant factors in the preferred pedaling rate of elite cyclists. The aim of this study was to monitor the diurnal variation of spontaneous pedaling rate and movement kinematics over the cr...
journal_title:Chronobiology international
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journal_title:Chronobiology international
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Chronobiology international
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journal_title:Chronobiology international
pub_type: 杂志文章
doi:10.1080/07420520500262989
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abstract::Therapy with oral anticoagulants (OACs) is a risk factor for cerebral hemorrhage (CH). Although different studies have been undertaken to investigate the timing of the onset of major cardiovascular events, no data exist on temporal patterns of the onset of CH in subjects treated with OACs. The aim of this study is to ...
journal_title:Chronobiology international
pub_type: 杂志文章,多中心研究
doi:10.3109/07420528.2015.1133636
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journal_title:Chronobiology international
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journal_title:Chronobiology international
pub_type: 杂志文章
doi:10.1080/07420528.2020.1764012
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journal_title:Chronobiology international
pub_type: 杂志文章
doi:10.3109/07420528909064628
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journal_title:Chronobiology international
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Chronobiology international
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journal_title:Chronobiology international
pub_type: 杂志文章,多中心研究,随机对照试验
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