Effects of chronotherapy on blood pressure control in non-dipper patients with refractory hypertension
Background. Refractory arterial hypertension (RAH) is frequently associated to a non-dipping blood pressure (BP) pattern; this profile has been shown to have a worse clinical prognosis. It is a common clinical practice that patients receive anti-hypertensive medication preferentially in the morning....
| Autores: | , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2012 |
| País: | España |
| Institución: | Institut d'Investigació i Innovació Parc Taulí (I3PT) |
| Repositorio: | r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
| OAI Identifier: | oai:dnet:r-i3pt______::36971a0a7d00c12c03644153ad18c72a |
| Acceso en línea: | https://i3pt.portalinvestigacion.com/publicaciones/7039 |
| Access Level: | acceso abierto |
| Palabra clave: | ambulatory blood pressure monitoring chronotherapy circadian rhythm non-dipper refractory hypertension |
| Sumario: | Background. Refractory arterial hypertension (RAH) is frequently associated to a non-dipping blood pressure (BP) pattern; this profile has been shown to have a worse clinical prognosis. It is a common clinical practice that patients receive anti-hypertensive medication preferentially in the morning. Non-dipping could be related to the timing of anti-hypertensive drug administration. We analysed whether switching anti-hypertensive medication to bedtime could improve BP control in non-dipper patients with RAH. Methods. Twenty-seven consecutive patients with RAH and non-dipper or riser BP pattern on ambulatory blood pressure (ABP) monitoring were studied before and after 6 weeks of a change in the timing of anti-hypertensive medications. The intervention consisted of shifting all non-diuretic anti-hypertensive drugs from morning to evening, maintaining the same drugs at the same doses. A parallel group of 12 consecutive patients with similar characteristics and no changes in the therapeutic regimen formed the control group. Results. There were 59% women, mean age 65.7+/-8.4 years. They were treated with 4+/-0.7 anti-hypertensive drugs, 90% administered in the morning. At baseline, diurnal and nocturnal ABP averaged 141.6+/-10.6/81.5+/-9.3 and 141.7+/-11/78+/-8.8, respectively. After the drug shift, mean diurnal and nocturnal ABP was 140.5+/-10.4/80.5+/-9.6 and 135.7+/-12.5/73.8+/-9.3 (P=0.005 and 0.04 for systolic and diastolic ABP), 15% of the patients restored a normal ABP circadian rhythm. No changes were observed in the control group. Conclusion. In non-dipper or riser patients with RAH, changing the timing of anti-hypertensive medication to the evening could improve BP control. |
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