Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA.
Curr Hypertens Rep. 2018 Sep 28;20(11):97. doi: 10.1007/s11906-018-0897-4.
Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk.
To more effectively reduce nocturnal blood pressure and still counteract the morning surge in blood pressure, a number of studies have examined moving one or more antihypertensives from morning to bedtime dosing. More recently, such studies of chronotherapy have studied comorbid populations including obstructive sleep apnea, chronic kidney disease, or diabetes. Here, we summarize major findings from recent research in this area (2013-2017). In general, nighttime administration of antihypertensives improved overall 24-h blood pressure profiles regardless of disease comorbidity. However, inconsistencies between studies suggest a need for more prospective randomized controlled trials with sufficient statistical power. In addition, experimental studies to ascertain mechanisms by which chronotherapy is beneficial could aid drug design and guidelines for timed administration.
鉴于昼夜节律存在于每个细胞和所有器官系统中的新知识不断涌现，人们对chronotherapy（时间疗法）治疗许多疾病的可能益处越来越感兴趣。血压有一个有据可查的 24 小时模式，存在晨峰，这可能导致观察到的心血管不良事件在早晨增加。从历史上看，抗高血压治疗涉及早晨剂量，通常旨在降低白天的血压高峰，但夜间血压无下降也与心血管风险增加有关。
为了更有效地降低夜间血压，同时抵消血压的晨峰，许多研究已经研究了将一种或多种降压药从早晨剂量改为睡前剂量。最近，这些时间疗法的研究研究了合并症人群，包括阻塞性睡眠呼吸暂停、慢性肾脏病或糖尿病。在这里，我们总结了该领域（2013-2017 年）最近研究的主要发现。一般来说，降压药在夜间给药可改善全天 24 小时的血压谱，无论合并症如何。然而，研究之间的不一致表明需要进行更多具有足够统计效力的前瞻性随机对照试验。此外，确定时间疗法有益的机制的实验研究可以帮助药物设计和定时给药指南。
