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Vol. 154. Issue 12.
Pages 505-511 (June 2020)
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Vol. 154. Issue 12.
Pages 505-511 (June 2020)
Review
DOI: 10.1016/j.medcle.2020.02.003
Chronotherapy for reduction of cardiovascular risk
Cronoterapia para reducción de riesgo cardiovascular
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Ramón C. Hermidaa,b,
Corresponding author
rhermida@uvigo.es

Corresponding author.
, Ramón G. Hermida-Ayalac, Michael Smolenskyb
a Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Vigo, Spain
b Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, United States
c Chief Parmacology Officer (CPO), Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, La Coruña, Spain
Article information
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Abstract

Numerous prospective studies establish that elevated asleep blood pressure (BP) constitutes a significant cardiovascular disease (CVD) risk factor, irrespective of daytime office BP measurements or awake and 24h BP measurements. Moreover, except for a small number of studies with flawed methodology, multiple clinical trials of high consistency document significantly better BP-lowering efficacy of hypertension medication and their combinations when ingested at bedtime compared to upon awakening as is customary. Additionally, recent trials conclude bedtime hypertension chronotherapy markedly reduces CVD risk not only in the general population, but also in more vulnerable patients of advanced age, with kidney disease, diabetes, or resistant hypertension. Collectively, these results call for a new definition of true arterial hypertension and its proper diagnosis and management.

Keywords:
Chronobiology
Chronotherapy
Ambulatory blood pressure monitoring
Asleep blood pressure
Sleep-time relative blood pressure decline
Cardiovascular risk
Diagnosis of hypertension
Diabetes
Kidney disease
Resumen

Diversos estudios prospectivos han demostrado de forma concordante que la elevación en la media de descanso de la presión arterial (PA) constituye un factor de riesgo cardiovascular (CV) significativo e independiente de la PA clínica, o de las medias de actividad o de 24horas derivadas de la monitorización ambulatoria de la PA. Además, múltiples ensayos clínicos de cronoterapia documentan, con pocas discrepancias debidas a deficiencias metodológicas, mayor eficacia en la reducción de la PA durante el sueño cuando los antihipertensivos se ingieren al acostarse en lugar de al levantarse. Estudios prospectivos recientes indican también que la cronoterapia antihipertensiva al acostarse reduce el riesgo de eventos CV no solo en población general, sino en los pacientes más vulnerables con edad avanzada, enfermedad renal, diabetes o hipertensión resistente. En su conjunto, estos resultados indican la necesidad de establecer una nueva definición de hipertensión, así como de estrategias adecuadas para su tratamiento.

Palabras clave:
Cronobiología
Cronoterapia
Monitorización ambulatoria de la presión arterial
Presión arterial durante el sueño
Profundidad de la presión arterial
Riesgo cardiovascular
Diagnóstico de hipertensión
Diabetes
Enfermedad renal

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