Time of angiotensin II receptor blockers intake and their antihypertensive effect: own experience of chronotherapy
Keywords:arterial hypertension, chronotherapy, circadian rhythm, evening intake, morning intake
Background. The purpose of our study was to evaluate the effect of angiotensin (AT) II receptor blockers — olmesartan, azilsartan, and telmisartan when taken in the morning or evening hours on blood pressure indicators during 24-hour monitoring. Materials and methods. The study included 126 patients with mild to moderate hypertension. The patients were divided into 6 groups: group 1 — 20 patients who took olmesartan 20–40 mg in the morning, group 2 — 20 patients took olmesartan 20–40 mg in the evening, group 3 — 21 patients took azilsartan 40–80 mg in the morning, group 4 — 20 patients took azilsartan 40–80 mg in the evening, group 5 — 22 patients took telmisartan 40–80 mg in the morning, group 6 — 23 patients took telmisartan 40–80 mg in the evening. Patients underwent initial and repeated examination after 3 months of therapy. Results. Evening intake of olmesartan led to a more pronounced decrease in 24 systolic blood pressure (SBP) (11.09 ± 2.30 versus 4.06 ± 2.25 mm Hg; p < 0.01). Changes in 24 diastolic blood pressure (DBP) were insignificant, although the decrease, when taken in the evening was more significant compared to the morning intake (8.38 ± 2.58 versus 3.38 ± 2.31 mm Hg, NS). Changes in 24SBP/24DBP while taking azilsartan in the evening or morning hours were significant but did not differ from each other (13.06 ± 2.65/9.76 ± 1.73 and 12.71 ± 1.62/7.00 ± 1.50 mm Hg). The decrease in 24SBP/24SBP on the background of telmisartan intake was significantly more pronounced with the morning intake compared to the evening intake (16.48 ± ± 2.86/12.56 ± 2.80 versus 4.93 ± 1.53/5.40 ± 1.89 mm Hg; p < 0.01) Thus, the morning intake more strongly reduced the average daily blood pressure while taking telmisartan, and the evening intake — while taking olmesartan. Azilsartan reduced blood pressure equally both when taken in the evening and in the morning. Achievement of target blood pressure with daily monitoring while taking olmesartan, azilsartan and telmisartan was 71.80, 71.05, and 75.61 %, respectively. Conclusions. The study of various AT II blockers (olmesartan, azilsartan, and telmisartan) has demonstrated their different properties in terms of impacting the daily blood pressure level depending on the time of administration. We did not reveal the class effect of the drugs by the time of their administration: olmesartan was more effective when taken in the evening, telmisartan — in the morning, and the effectiveness of azilsartan did not depend on the time of its administration. Achievements of target blood pressure while taking all three drugs according to 24-hour monitoring data were the same.
Bartter F.C., Delea C.S., Baker W. Chronobiology in the diagnosis and treatment of hypertension. Chronobiologia. 1976. 3(3). 199-213. doi.org/10.1007/978-1-4684-2847-6_10.
Bowles N.P., Thosar S.S., Herzig M.X. et al. Chronotherapy for Hypertension. Current Hypertension Reports. 2018. 20. 97. https://doi.org/10.1007/s11906-018-0897-4.
Hermida R., Ayala D., Mojón A. et al. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol. Int. 2010. 27(8). 1629-1651.
Hermida R.C., Ayala D.E., Mojón A. et al. Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial. Diabetologia. 2016. 59. 255-265.
Hermida R.C., Ayala D.E., Mojón A. et al. Prognostic marker of type 2 diabetes and therapeutic target for prevention. Diabetologia. 2016. 59. 244-254.
Hermida R.C., Ayala D.E., Mojón A. et al. Bedtime do-
sing of antihypertensive medications reduces cardiovascular risk in CKD. J. Am. Soc. Nephrol. 2011. 22(12). 2313-2321.
Hermida R.C., Ayala D.E., Mojón A. et al. Effects of time of antihypertensive treatment on ambulatory blood pressure and clinical characteristics of subjects with resistant hypertension. Am. J. Hypertens. 2010. 23. 432-439.
Hermida R.C., Ayala D.E., Mojón A. et al. Influence of time of day of blood pressure–lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care. 2011. 34(6). 1270-1276.
Hermida R.C., Smolensky M.H., Ayala D.E. et al. Ambulatory blood pressure monitoring (ABPM) as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults. Chronobiol. Int. 2015. 32. 1329-1342.
Judd E., Calhoun D. Management of Hypertension in CKD: Beyond the Guidelines. Adv. Chronic Kidney Dis. 2015. 22(2). 116-122. doi: 10.1053/j.ackd.2014.12.001.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. Suppl. 2013. 3. 100-150.
Manfredini R., Fabbian F. A pill at bedtime, and your heart is fine? Bedtime hypertension chronotherapy: an opportune and advantageous inexpensive treatment strategy. Sleep Med. Rev. 2017. 33. 1-3.
Orías M., Correa-Rotter R. Chronotherapy in hypertension: a pill at night makes things right? J. Am. Soc. Nephrol. 2011. 22(12). 2152-2155.
Rahman M., Greene T., Phillips R.A. et al. A Trial of two strategies to reduce nocturnal blood pressure in african americans with chronic kidney disease. Hypertension. 2013 January. 61(1). 82-88. doi: 10.1161/HYPERTENSIONAHA.112.200477.
Hermida R.C., Ayala D.E. et al. Bedtime Blood Pressure Chronotherapy Significantly Improves Hypertension Management. Heart Failure Clin. 2017. http://dx.doi.org/10.1016/j.hfc.2017.05.010 1551-7136/17/.
Shen Y., Lu X. Clinical study of taking medicine at bedtime for CKD patients to reduce cardiovascular events. Mod. Instrum. Med. Treatment. 2014. 20. 89-91.
Sleight P. The HOPE Study (Heart Outcomes Prevention Evaluation). J. Renin-Angiotensin-Aldosterone Syst. 2000. 1(1). 18-20.
Smolensky M.H., Hermida, R.C., Ayala D. E. et al. Bedtime Chronotherapy with Conventional Hypertension Medications to Target Increased Asleep Blood Pressure Results in Markedly Better Chronoprevention of Cardiovascular and Other Risks than Customary On-awakening Therapy. Heart Failure Clin. 2017). http://dx.doi.org/10.1016/j.hfc.2017.05.011.
Smolensky M.H., Hermida R.C., Ayala D.E. et al. Bedtime hypertension chronotherapy: concepts and patient outcomes. Curr. Pharm. Des. 2015. 21(6). 773-790. doi.org/10.2174/1381612820666141024150542.
Staessen J., Fagard R., Thijs L. et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997. 350(9080). 757-764. doi.org/10.1016/s0140-6736(97)05381-6.
Yusuf S., Sleight P., Pogue J. et al. Effects of an angiotensin- converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N. Engl. J. Med. 2000. 342. 145-153. doi.org/10.1056/nejm200003093421023.
Jatoi N.A., Azra Mahmud, Kathleen Bennett et al. Assessment of arterial stiffness in hypertension: comparison of oscillometric (Arteriograph), piezoelectronic (Complior) and tonometric (SphygmoCor) techniques. J. Hypertens. 2009. Vol. 27. № 11. 2186-2191. doi.org/10.1097/hjh.0b013e32833057e8.
Mitchell G.F., Hwang Shih-Jen, Vasan R.S. Arterial stiffness and cardiovascular events: the Framingham heart study. Circulation. 2010. Vol. 121. № 4. 505-511. doi.org/10.1161/circulationaha.109.886655.
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