New perspectives on the definition, diagnosis, and treatment of true arterial hypertension
| Autor: | Juan J. Crespo, Alfonso Otero, José R. Fernández, Michael H. Smolensky, Ramon C. Hermida, Artemio Mojón, María T Ríos, Manuel Domínguez-Sardiña |
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| Rok vydání: | 2020 |
| Předmět: |
Pharmacology
Male medicine.medical_specialty Ambulatory blood pressure business.industry General Medicine medicine.disease 03 medical and health sciences 0302 clinical medicine Blood pressure 030220 oncology & carcinogenesis Diabetes mellitus Hypertension medicine Humans Pharmacology (medical) Female Prospective Studies Intensive care medicine business 030217 neurology & neurosurgery Antihypertensive Agents |
| Zdroj: | Expert opinion on pharmacotherapy. 21(10) |
| ISSN: | 1744-7666 |
| Popis: | Office blood pressure measurements (OBPM), still used today for diagnosis and management of hypertension, fail to reveal clinically important features of the mostly predictable blood pressure (BP) 24 h pattern, and lead to45% of individuals being misclassified. Current hypertension guidelines do not provide recommendation on when-to-treat, despite multiple prospective clinical trials documenting improved normalization of 24 h BP pattern and significant reduction in cardiovascular disease (CVD) events when hypertension medications are ingested at bedtime rather than upon waking.In this review, the authors discuss current evidence on the: (i) most relevant attributes of the 24 h BP pattern deterministic of CVD risk; (ii) asleep systolic BP (SBP) mean as the most significant therapeutic target for CVD risk reduction; (iii) ingestion-time differences in pharmacodynamics of BP-lowering medications as reported with high consistency in multiple clinical trials; and (iv) enhanced prevention of CVD events achieved by bedtime hypertension chronotherapy.Several prospective trials consistently document asleep SBP mean and sleep-time relative SBP decline (dipping) constitute highly significant CVD risk factors, independent of OBPM. Bedtime, compared to customary upon-waking, hypertension chronotherapy reduces risk of major CVD events. Collectively, these findings call for new definition of true hypertension and, accordingly, its proper diagnosis and management. |
| Databáze: | OpenAIRE |
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