Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial.
Ramon C. Hermida,Juan J. Crespo,Manuel Domínguez-Sardiña,Alfonso Otero,Ana Moyá,María T Ríos,Elvira Sineiro,M.C. Castiñeira,Pedro A. Callejas,Lorenzo Pousa,José L Salgado,Carmen Durán,Juan J Sánchez,José R. Fernández,Artemio Mojón,Diana E. Ayala +15 more
Reads0
Chats0
TLDR
Routine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control and, most importantly, markedly diminished occurrence of major CVD events.Abstract:
AIMS The Hygia Chronotherapy Trial, conducted within the clinical primary care setting, was designed to test whether bedtime in comparison to usual upon awakening hypertension therapy exerts better cardiovascular disease (CVD) risk reduction. METHODS AND RESULTS In this multicentre, controlled, prospective endpoint trial, 19 084 hypertensive patients (10 614 men/8470 women, 60.5 ± 13.7 years of age) were assigned (1:1) to ingest the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ambulatory blood pressure (ABP) monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome (CVD death, myocardial infarction, coronary revascularization, heart failure, or stroke). Patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower hazard ratio-adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic blood pressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event-of the primary CVD outcome [0.55 (95% CI 0.50-0.61), P < 0.001] and each of its single components (P < 0.001 in all cases), i.e. CVD death [0.44 (0.34-0.56)], myocardial infarction [0.66 (0.52-0.84)], coronary revascularization [0.60 (0.47-0.75)], heart failure [0.58 (0.49-0.70)], and stroke [0.51 (0.41-0.63)]. CONCLUSION Routine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e. BP dipping) and, most importantly, markedly diminished occurrence of major CVD events. TRIAL REGISTRATION ClinicalTrials.gov, number NCT00741585.read more
Citations
More filters
Journal ArticleDOI
Circadian disruption and human health.
TL;DR: In this paper, the authors discuss the implications of circadian disruption for human health using a bench-to-bedside approach, focusing on selected examples in neurologic, psychiatric, metabolic, cardiovascular, allergic, and immunologic disorders that highlight the interrelatedness between circadian disruption and human disease.
Journal ArticleDOI
Cuffless Blood Pressure Monitoring: Promises and Challenges
TL;DR: The progression in the field, particularly in the last 5 years, is discussed, ending with sensor-based approaches that incorporate machine learning algorithms to personalized medicine.
Journal ArticleDOI
Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial
TL;DR: The Treatment in Morning versus Evening (TIME) study as discussed by the authors investigated whether evening dosing of usual antihypertensive medication improves major cardiovascular outcomes compared with morning dosing in patients with hypertension.
Journal ArticleDOI
Gender Differences in Cardiovascular Pharmacotherapy-the Example of Hypertension: A Mini Review.
Jacklean Kalibala,Antoinette Pechère-Bertschi,Jules Alexandre Desmeules,Jules Alexandre Desmeules +3 more
TL;DR: The known pharmacological and pharmacokinetic sex differences with special attention to the main classes of antihypertensive treatment are explored and sex-divergent effects of drugs is still under investigation.
Journal ArticleDOI
Blood pressure medication should not be routinely dosed at bedtime. We must disregard the data from the HYGIA project
Reinhold Kreutz,Sverre E. Kjeldsen,Michel Burnier,Krzysztof Narkiewicz,Suzanne Oparil,Giuseppe Mancia +5 more
TL;DR: Because they were intrigued by the results, many colleagues and journalists have made us aware of the paper.
References
More filters
Journal ArticleDOI
A New Equation to Estimate Glomerular Filtration Rate
Andrew S. Levey,Lesley A. Stevens,Christopher H. Schmid,Yaping (Lucy) Zhang,Alejandro F. Castro,Harold I. Feldman,John W. Kusek,Paul W. Eggers,Frederick Van Lente,Tom Greene,Josef Coresh +10 more
TL;DR: The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use.
Journal ArticleDOI
2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).
Giuseppe Mancia,Robert Fagard,Krzysztof Narkiewicz,Josep Redon,Alberto Zanchetti,Michael Böhm,Thierry Christiaens,Renata Cifkova,Guy De Backer,Anna F. Dominiczak,Maurizio Galderisi,Diederick E. Grobbee,Tiny Jaarsma,Paulus Kirchhof,Sverre E. Kjeldsen,Stéphane Laurent,Athanasios J. Manolis,Peter M. Nilsson,Luis M. Ruilope,Roland E. Schmieder,Per Anton Sirnes,Peter Sleight,Margus Viigimaa,Bernard Waeber,Faiez Zannad,Michel Burnier,Ettore Ambrosioni,Mark Caufield,Antonio Coca,Michael H. Olsen,Costas Tsioufis,Philippe van de Borne,José Luis Zamorano,Stephan Achenbach,Helmut Baumgartner,Jeroen J. Bax,Héctor Bueno,Veronica Dean,Christi Deaton,Çetin Erol,Roberto Ferrari,David Hasdai,Arno W. Hoes,Juhani Knuuti,Philippe Kolh,Patrizio Lancellotti,Aleš Linhart,Petros Nihoyannopoulos,Massimo F Piepoli,Piotr Ponikowski,Juan Tamargo,Michal Tendera,Adam Torbicki,William Wijns,Stephan Windecker,Denis Clement,Thierry C. Gillebert,Enrico Agabiti Rosei,Stefan D. Anker,Johann Bauersachs,Jana Brguljan Hitij,Mark J. Caulfield,Marc De Buyzere,Sabina De Geest,Geneviève Derumeaux,Serap Erdine,Csaba Farsang,Christian Funck-Brentano,Vjekoslav Gerc,Giuseppe Germanò,Stephan Gielen,Herman Haller,Jens Jordan,Thomas Kahan,Michel Komajda,Dragan Lovic,Heiko Mahrholdt,Jan Östergren,Gianfranco Parati,Joep Perk,Jorge Polónia,Bogdan A. Popescu,Zeljko Reiner,Lars Rydén,Yuriy Sirenko,Alice Stanton,Harry A.J. Struijker-Boudier,Charalambos Vlachopoulos,Massimo Volpe,David A. Wood +89 more
TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
Journal ArticleDOI
Standards of medical care in diabetes.
TL;DR: I would like to take issue with the use of the phrase “standards of medical care in diabetes,” which is used to describe diabetes care standards, in the recently updated and circulatedADA 2006 Clinical Practice Recommendations.
Journal ArticleDOI
Effects of an angiotensin-converting -enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients
TL;DR: Ramipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure.
Journal ArticleDOI
2018 ESC/ESH Guidelines for the management of arterial hypertension.
B. Williams,G. Mancia,Wilko Spiering,Agabiti Rosei E,M. Azizi,Michel Burnier,Denis Clement,A. Coca,de Simone G,A Dominiczak,T. Kahan,Felix Mahfoud,Josep Redon,L.M. Ruilope,Alberto Zanchetti,Mary Kerins,S.E. Kjeldsen,Reinhold Kreutz,S. Laurent,Lip Gyh.,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,R.E. Schmieder,Evgeny Shlyakhto,Constantinos Tsioufis,Aboyans,Ileana Desormais +27 more
Related Papers (5)
2018 ESC/ESH Guidelines for the management of arterial hypertension.
B. Williams,G. Mancia,Wilko Spiering,Agabiti Rosei E,M. Azizi,Michel Burnier,Denis Clement,A. Coca,de Simone G,A Dominiczak,T. Kahan,Felix Mahfoud,Josep Redon,L.M. Ruilope,Alberto Zanchetti,Mary Kerins,S.E. Kjeldsen,Reinhold Kreutz,S. Laurent,Lip Gyh.,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,R.E. Schmieder,Evgeny Shlyakhto,Constantinos Tsioufis,Aboyans,Ileana Desormais +27 more