Bedtime hypertension treatment improves cardiovascular risk reduction the Hygia Chronotherapy Trial (2019)
1 de outubro de 2019 às 20:03
Autores: Ramón C. Hermida, Juan J. Crespo, Manuel Domínguez-Sardiña, Alfonso Otero , Ana Moyá, María T. Ríos, Elvira Sineiro, María C. Castiñeira, Pedro A. Callejas, Lorenzo Pousa, José L. Salgado, Carmen Durán, Juan J. Sánchez, José R. Fernández , Artemio Mojón, and Diana E. Ayala
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 sleeptime relative BP decline, i.e. BP dipping
Keywords: Bedtime hypertension chronotherapy, Asleep blood pressure, Ambulatory blood pressure monitoring, Cardiovascular risk, Stroke, Heart failure, Myocardial infarction, Coronary revascularization, Angiotensin-II receptor blockers, Angiotensin-converting enzyme inhibitors