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Optimal timing for antihypertensive dosing: focus on valsartan.

Hermida RC, Ayala DE, Calvo C - Ther Clin Risk Manag (2007)

Bottom Line: Thus, bedtime dosing with nifedipine gastrointestinal therapeutic system (GITS) is more effective than morning dosing, while also reducing significantly secondary effects.The dose-response curve, therapeutic coverage, and efficacy of doxazosin GITS are all markedly dependent on the circadian time of drug administration.Moreover, valsartan administration at bedtime as opposed to upon wakening results in improved diurnal/nocturnal ratio, a significant increase in the percentage of patients with controlled BP after treatment, and significant reductions in urinary albumin excretion and plasma fibrinogen.

View Article: PubMed Central - PubMed

ABSTRACT
Some specific features of the 24 h blood pressure (BP) pattern are linked to the progressive injury of target tissues and the triggering of cardiac and cerebrovascular events. In particular, many studies show the extent of the nocturnal BP decline relative to the diurnal BP mean (the diurnal/nocturnal ratio, an index of BP dipping) is deterministic of cardiovascular injury and risk. Normalization of the circadian BP pattern is considered to be an important clinical goal of pharmacotherapy because it may slow the advance of renal injury and avert end-stage renal failure. The chronotherapy of hypertension takes into account the epidemiology of the BP pattern, plus potential administration-time determinants of the pharmacokinetics and dynamics of antihypertensive medications, as a means of enhancing beneficial outcomes and/or attenuating or averting adverse effects. Thus, bedtime dosing with nifedipine gastrointestinal therapeutic system (GITS) is more effective than morning dosing, while also reducing significantly secondary effects. The dose-response curve, therapeutic coverage, and efficacy of doxazosin GITS are all markedly dependent on the circadian time of drug administration. Moreover, valsartan administration at bedtime as opposed to upon wakening results in improved diurnal/nocturnal ratio, a significant increase in the percentage of patients with controlled BP after treatment, and significant reductions in urinary albumin excretion and plasma fibrinogen. Chronotherapy provides a means of individualizing treatment of hypertension according to the circadian BP profile of each patient, and constitutes a new option to optimize BP control and reduce risk.

No MeSH data available.


Related in: MedlinePlus

Effects on the diurnal, nocturnal, and 24 h mean of systolic blood pressure (SBP) (top) and dystolic blood pressure (DBP) (bottom) of valsartan (160 mg/day) administered on awakening or at bedtime in nondipper patients with grade 1 or 2 essential hypertension studied by 48 h ambulatory monitoring before and after 3 months of treatment. Probability values are shown for comparison of effects between the 2 groups of subjects by ANOVA.
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fig3: Effects on the diurnal, nocturnal, and 24 h mean of systolic blood pressure (SBP) (top) and dystolic blood pressure (DBP) (bottom) of valsartan (160 mg/day) administered on awakening or at bedtime in nondipper patients with grade 1 or 2 essential hypertension studied by 48 h ambulatory monitoring before and after 3 months of treatment. Probability values are shown for comparison of effects between the 2 groups of subjects by ANOVA.

Mentions: The comparison of results shown in Figures 1 and 2 revealed lack of statistically significant differences in ambulatory BP at baseline among the 2 treatment groups. After 3 months of timed treatment, the 24 h mean BP was also similar for both groups; accordingly, the treatment efficacy of valsartan on the 24 h of BP was comparable and independent of the time of its administration. The effect of medication on the nocturnal mean of BP was, however, significantly greater when valsartan was administered at bedtime. Figure 3 provides additional information on the comparison between the treatment groups of the changes in the diurnal, nocturnal, and 24 h mean BP values after 3 months of therapy. Figure 3 reveals the significant difference between the treatment-groups in the effect of valsartan on the nocturnal mean of SBP and DBP (p<0.001).


Optimal timing for antihypertensive dosing: focus on valsartan.

Hermida RC, Ayala DE, Calvo C - Ther Clin Risk Manag (2007)

Effects on the diurnal, nocturnal, and 24 h mean of systolic blood pressure (SBP) (top) and dystolic blood pressure (DBP) (bottom) of valsartan (160 mg/day) administered on awakening or at bedtime in nondipper patients with grade 1 or 2 essential hypertension studied by 48 h ambulatory monitoring before and after 3 months of treatment. Probability values are shown for comparison of effects between the 2 groups of subjects by ANOVA.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1936293&req=5

fig3: Effects on the diurnal, nocturnal, and 24 h mean of systolic blood pressure (SBP) (top) and dystolic blood pressure (DBP) (bottom) of valsartan (160 mg/day) administered on awakening or at bedtime in nondipper patients with grade 1 or 2 essential hypertension studied by 48 h ambulatory monitoring before and after 3 months of treatment. Probability values are shown for comparison of effects between the 2 groups of subjects by ANOVA.
Mentions: The comparison of results shown in Figures 1 and 2 revealed lack of statistically significant differences in ambulatory BP at baseline among the 2 treatment groups. After 3 months of timed treatment, the 24 h mean BP was also similar for both groups; accordingly, the treatment efficacy of valsartan on the 24 h of BP was comparable and independent of the time of its administration. The effect of medication on the nocturnal mean of BP was, however, significantly greater when valsartan was administered at bedtime. Figure 3 provides additional information on the comparison between the treatment groups of the changes in the diurnal, nocturnal, and 24 h mean BP values after 3 months of therapy. Figure 3 reveals the significant difference between the treatment-groups in the effect of valsartan on the nocturnal mean of SBP and DBP (p<0.001).

Bottom Line: Thus, bedtime dosing with nifedipine gastrointestinal therapeutic system (GITS) is more effective than morning dosing, while also reducing significantly secondary effects.The dose-response curve, therapeutic coverage, and efficacy of doxazosin GITS are all markedly dependent on the circadian time of drug administration.Moreover, valsartan administration at bedtime as opposed to upon wakening results in improved diurnal/nocturnal ratio, a significant increase in the percentage of patients with controlled BP after treatment, and significant reductions in urinary albumin excretion and plasma fibrinogen.

View Article: PubMed Central - PubMed

ABSTRACT
Some specific features of the 24 h blood pressure (BP) pattern are linked to the progressive injury of target tissues and the triggering of cardiac and cerebrovascular events. In particular, many studies show the extent of the nocturnal BP decline relative to the diurnal BP mean (the diurnal/nocturnal ratio, an index of BP dipping) is deterministic of cardiovascular injury and risk. Normalization of the circadian BP pattern is considered to be an important clinical goal of pharmacotherapy because it may slow the advance of renal injury and avert end-stage renal failure. The chronotherapy of hypertension takes into account the epidemiology of the BP pattern, plus potential administration-time determinants of the pharmacokinetics and dynamics of antihypertensive medications, as a means of enhancing beneficial outcomes and/or attenuating or averting adverse effects. Thus, bedtime dosing with nifedipine gastrointestinal therapeutic system (GITS) is more effective than morning dosing, while also reducing significantly secondary effects. The dose-response curve, therapeutic coverage, and efficacy of doxazosin GITS are all markedly dependent on the circadian time of drug administration. Moreover, valsartan administration at bedtime as opposed to upon wakening results in improved diurnal/nocturnal ratio, a significant increase in the percentage of patients with controlled BP after treatment, and significant reductions in urinary albumin excretion and plasma fibrinogen. Chronotherapy provides a means of individualizing treatment of hypertension according to the circadian BP profile of each patient, and constitutes a new option to optimize BP control and reduce risk.

No MeSH data available.


Related in: MedlinePlus