Is your doctor figuring out how to get your sleep-time blood pressure? And update your
chronotherapy protocol?
http://www.smrv-journal.com/article/S1087-0792%2816%2930007-7/fulltext?rss=yes
Summary
Correlation
between blood pressure (BP) and target organ damage, vascular risk, and
long-term patient prognosis is stronger for measurements derived from
around-the-clock ambulatory BP monitoring (ABPM) than in-clinic daytime
ones. Numerous studies consistently substantiate the asleep BP mean is
both an independent and much better predictor of cardiovascular disease
(CVD) risk than either the awake or 24 h means. Elevated sleep-time BP,
i.e., sleep-time hypertension, which can only be diagnosed by
around-the-clock ABPM, is much more common than suspected, not only in
patients with sleep disorders, but, among others, in those who are
elderly or have type 2 diabetes, chronic kidney disease, or resistant
hypertension. Hence, medical guidelines increasingly recommend ABPM to
make the accurate differential diagnosis of hypertension versus
normotension and recognize the marked clinical importance of adequate
management of sleep-time BP. The ingestion time, according to circadian
rhythms, of hypertension medications of six different classes and their
combinations significantly impacts their beneficial, particularly on
sleep-time BP control, and/or adverse effects. The MAPEC (monitorización
ambulatoria para predicción de eventos cardiovasculares (i.e.,
ambulatory blood pressure monitoring for prediction of cardiovascular
events)) study was the first prospective randomized treatment-time
investigation designed to test the worthiness of bedtime
chronotherapy
with ≥1 conventional hypertension medications to specifically target
attenuation of asleep BP. This 5.6 y median follow-up outcomes trial
found the bedtime
chronotherapy strategy most advantageous, resulting in
the differential reduction of total CVD events by 61% and
decrease of
major CVD events – CVD death, myocardial infarction, and ischemic and
hemorrhagic stroke – by 67%. The MAPEC study plus other earlier
conducted less refined trials document the asleep BP mean is the most
significant prognostic marker of CVD morbidity and mortality. It further
substantiates attenuation of the asleep BP mean by a bedtime
hypertension treatment strategy entailing the entire daily dose of ≥1
hypertension medications significantly reduces CVD risk, both in the
general hypertension population and in more vulnerable patients, i.e.,
those diagnosed with chronic kidney disease, diabetes, and resistant
hypertension.
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