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

G. Cornelissen, A. Havelkova, J. Siegelova, D. Gubin, L. A. Beaty, K. Otsuka

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

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 anti¬hypertensive 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.

Original languageEnglish (US)
Title of host publicationNoninvasive Methods in Cardiology 2023
PublisherMasaryk University
Pages9-25
Number of pages17
ISBN (Electronic)9788028004415
StatePublished - Jan 1 2023

Bibliographical note

Publisher Copyright:
© 2023 Masaryk University.

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