Statement on chronotherapy for the treatment of hypertension: consensus document from the Korean society of hypertension

Clinical Hypertension

Review

Seonghoon Choi¹  Jae Hyeong Park²  Ju Han Kim³  Il Suk Sohn⁴  Kwang-il Kim⁵  Hyeon Chang Kim⁶  Dae-Hee Kim⁷  In-Jeong Cho⁸  Jinho Shin⁹  Ki-Chul Sung^1,10  Hae Young Lee^1,11  Woo-Baek Chung^1,12  Eun Mi Lee^1,13  Eun Joo Cho^1,14  Sungha Park^1,15  Wook Bum Pyun^1,16  Sang-Hyun Ihm^1,17 

[1] Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea;Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea;Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea;Department of Cardiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea;Department of Internal Medicine, Director of Geriatric center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Korea;Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea;Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea;Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea;Division of Cardiology, Department of Internal Medicine, Seoul St Mary’s Hospital, The Catholic University, Seoul, South Korea;Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, Republic of Korea;Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University College of Medicine, Seoul, Korea;Division of Cardiology, Severance Cardiovascular Hospital, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea;Division of cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea & Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;Division of cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea & Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea;

关键词: Blood pressure;    Hypertension;    Chronotherapy;    Antihypertensive;   

DOI  :  10.1186/s40885-023-00249-2

 received in 2023-05-16, accepted in 2023-08-11,  发布年份 2023

来源: Springer

【 摘 要 】

Nocturnal blood pressure (BP) has been shown to have a significant predictive value for cardiovascular disease. In some cases, it has a superior predictive value for future cardiovascular outcomes than daytime BP. As efficacy of BP medications wanes during nighttime and early morning, control of nocturnal hypertension and morning hypertension can be difficult. As such, chronotherapy, the dosing of BP medication in the evening, has been an ongoing topic of interest in the field of hypertension. Some studies have shown that chronotherapy is effective in reducing nocturnal BP, improving non dipping and rising patterns to dipping patterns, and improving cardiovascular prognosis. However, criticism and concerns have been raised regarding the design of these studies, such as the Hygia study, and the implausible clinical benefits in cardiovascular outcomes considering the degree of BP lowering from bedtime dosing. Studies have shown that there is no consistent evidence to suggest that routine administration of antihypertensive medications at bedtime can improve nocturnal BP and early morning BP control. However, in some cases of uncontrolled nocturnal hypertension and morning hypertension, such as in those with diabetes mellitus, chronic kidney disease, and obstructive sleep apnea, bedtime dosing has shown efficacy in reducing evening and early morning BP. The recently published the Treatment in Morning versus Evening (TIME) study failed to demonstrate benefit of bedtime dosing in reducing cardiovascular outcomes in patients with hypertension. With issues of the Hygia study and negative results from the TIME study, it is unclear at this time whether routine bedtime dosing is beneficial for reducing cardiovascular outcomes.

【 授权许可】

CC BY   
© The Korean Society of Hypertension 2023