Sleep-time blood pressure: Unique sensitive prognostic marker of vascular risk and therapeutic target for prevention

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

Ramón C. HermidaPress enter key for correspondence informationPress enter key to Email the author

,

Diana E. Ayala

,

Michael H. Smolensky

,

José R. Fernández

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Artemio Mojón

,

Francesco Portaluppi

DOI: http://dx.doi.org/10.1016/j.smrv.2016.04.001

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.

Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks

If I'm reading this correctly it would seem better to take your pills before you go to bed.
chronotherapy -  The practice of timing drugs at certain times of the day
Do not undertake any changes without talking to your doctor.  You'll know how up-to-date your doctor is if they can reference this study when talking to you.
http://www.nature.com/hr/journal/vaop/ncurrent/full/hr2015142a.html

Ramón C Hermida, Diana E Ayala, Michael H Smolensky, José R Fernández, Artemio Mojón and Francesco Portaluppi

Abstract

Correlation between blood pressure (BP) and target organ damage, vascular risk and long-term patient prognosis is greater for measurements derived from around-the-clock ambulatory BP monitoring than in-clinic daytime ones. Numerous studies consistently substantiate the asleep BP mean is both an independent and a much better predictor of cardiovascular disease (CVD) risk than either the awake or 24 h means. Sleep-time hypertension is much more prevalent than suspected, not only in patients with sleep disorders, but also among those who are elderly or have type 2 diabetes, chronic kidney disease or resistant hypertension. Hence, cost-effective adequate control of sleep-time BP is of marked clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of six different classes and their combinations significantly affects BP control, particularly sleep-time BP, and adverse effects. For example, because the high-amplitude circadian rhythm of the renin–angiotensin–aldosterone system activates during nighttime sleep, bedtime vs. morning ingestion of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers better reduces the asleep BP mean, with additional benefit, independent of medication terminal half-life, of converting the 24 h BP profile into more normal dipper patterning. The MAPEC (Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares) study, first prospective randomized treatment-time investigation designed to test the worthiness of bedtime chronotherapy with 1 conventional hypertension medications so as to specifically target attenuation of asleep BP, demonstrated, relative to conventional morning therapy, 61% reduction of total CVD events and 67% decrease of major CVD events, that is, CVD death, myocardial infarction, and ischemic and hemorrhagic stroke. The MAPEC study, along with other earlier conducted less refined trials, documents the asleep BP mean is the most significant prognostic marker of CVD morbidity and mortality; moreover, it 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 in both general and more vulnerable hypertensive patients, that is, those diagnosed with chronic kidney disease, diabetes and resistant hypertension.

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