Chronotherapy of Blood Pressure: Beyond Comparing Morning vs. Evening Dosing



Year of publication 2023
Type Article in Proceedings
Conference Noninvasive methods in cardiology 2023
MU Faculty or unit

Faculty of Medicine

Keywords Chronotherapy; Blood Pressur; Morning Dosing; Evening Dosing
Description The day-night ratio (DNR) of blood pressure (BP) is the index currently used most often by those relying on ambulatory blood pressure monitoring (ABPM) for the diagnosis and prognosis of hypertensive patients. It is also used as a gauge of the response to antihypertensive medication. Herein, we illustrate how ongoing debates regarding the relative merits of administering anti-hypertensive drugs in the morning or evening are misguided by trying to answer the wrong question. We review evidence showing that cardiovascular disease risk tends to be more strongly associated with a reverse dipping pattern of BP than with a nondipping pattern. We also offer some explanation why extreme dipping may be associated with increased risk in the elderly while it is protective in younger populations. Based on abstract models, we demonstrate that reliance on the circadian amplitude and phase interpreted in the light of chronobiologic reference values qualified by gender and age constitutes a more robust and more reliable approach than the classification in terms of dipping based on the DNR. We conclude by redefining the question to be answered in future clinical trials, leading to the suggestion of chronotherapy protocols aimed at a personalized treatment of BP disorders.

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