Cardiology Letters 2020, 29(3):148-153

An evening dose of antihypertensive drugs reduces cardiovascular risk - message of the Hygia Chronotherapy Trial

Gašpar Ľ^{1, 2}, Murín J¹

¹ I. interná klinika LF UK a UN Bratislava, Nemocnica Staré Mesto, Bratislava

² Inštitút fyzioterapie, balneológie a liečebnej rehabilitácie v Piešťanoch, Univerzita sv. Cyrila a Metoda v Trnave, Slovenská republika

Arterial hypertension is one of the most important risk factors for cardiovascular disease, including ischemic and hemorrhagic stroke, coronary heart disease, heart failure, as well as dementia, vision loss and kidney failure. The risk of cardiovascular complications increases continuously with blood pressure. Ambulatory blood pressure monitoring (ABPM) allows monitoring of circadian blood pressure variability with diurnal index determination. It also provides essential information on the efficacy of pharmacotherapy in relation to the reduction of blood pressure, the duration of efficacy of drugs over time (chronopharmacological aspects) and the effect of treatment on blood pressure variability. According to several studies, nocturnal blood pressure is a better predictor of cardiovascular morbidity and mortality than daily blood pressure values and preserved diurnal rhythm is associated with significantly better prognosis. The Hygia Chronotherapy Study, using the ABPM methodology, confirmed the clinical significance of chronopharmacology, as it demonstrated more effective BP control in those patients receiving antihypertensive therapy in the evening compared to patients receiving morning medication. With evening medication, the mean nocturnal pressure was significantly lower, while the beneficial antihypertensive effect persisted throughout the day. This drug dosing modality reduced the incidence of non-dippers, which was also of prognostic importance, as the incidence of all serious cardiovascular events was significantly lower.

Keywords: Hygia Chronotherapy Trial; Ambulatory Blood Pressure Monitoring (ABPM); diurnal rhythm dipping; medication at bedtime; prognosis

Published: March 1, 2020  Show citation