Возможности хронотерапии при артериальной гипертонии и коморбидных заболеваниях
Возможности хронотерапии при артериальной гипертонии и коморбидных заболеваниях
Леонова М.В. Возможности хронотерапии при артериальной гипертонии и коморбидных заболеваниях. Consilium Medicum. 2020; 22 (1): 31–37. DOI: 10.26442/20751753.2020.1.200022
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Leonova M.V. Opportunities of chronotherapy use in treatment of arterial hypertension and comorbid disorders. Consilium Medicum. 2020; 22 (1): 31–37. DOI: 10.26442/20751753.2020.1.200022
Возможности хронотерапии при артериальной гипертонии и коморбидных заболеваниях
Леонова М.В. Возможности хронотерапии при артериальной гипертонии и коморбидных заболеваниях. Consilium Medicum. 2020; 22 (1): 31–37. DOI: 10.26442/20751753.2020.1.200022
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Leonova M.V. Opportunities of chronotherapy use in treatment of arterial hypertension and comorbid disorders. Consilium Medicum. 2020; 22 (1): 31–37. DOI: 10.26442/20751753.2020.1.200022
Аннотация Хронотерапия артериальной гипертонии (АГ) заключается в применении антигипертензивных препаратов (АГП) в вечернее время, что особенно рационально при нарушенном суточном ритме артериального давления – АД (non-dipping, reverse dipping). В результате хронотерапии удается не только усилить гипотензивную эффективность и нормализовать ночное снижение АД, но и улучшить сердечно-сосудистый риск. Так, в последних крупных проспективных исследованиях (МАРЕС, n=3344, Hygia Chronotherapy Trial, n=19 084) вечерний прием ≥1 препарата сопровождается достоверным дополнительным снижением риска развития всех сердечно-сосудистых исходов на 61% и 45% соответственно. При оценке влияния хронотерапии для разных классов АГП наибольший эффект был отмечен для блокаторов ренин-ангиотензин-альдостероновой системы (ингибиторов ангиотензинпревращающего фермента, блокаторов рецепторов ангиотензина II) и антагонистов кальция. Позитивный эффект хронотерапии показан у пожилых пациентов с АГ, пациентов с резистентной АГ, сопутствующей хронической болезнью почек и сахарным диабетом. По данным рандомизированных клинических исследований и метаанализов, у пациентов с АГ и хронической болезнью почек вечерний прием АГП способствовал нормализации нарушенного суточного профиля АД и достижению ренопротективного эффекта (уменьшение протеинурии, повышение скорости клубочковой фильтрации), а также снижению относительного риска сердечно-сосудистых исходов почти на 70%. В исследовании МАРЕС у пациентов с АГ и сахарным диабетом вечерний прием АГП также приводил к нормализации суточного профиля АД и значимому снижению риска исходов около 70%. Кроме того, у пациентов без анамнеза диабета при хронотерапии с вечерним приемом АГП на фоне лучшего контроля уровня амбулаторных показателей АД отмечалось снижение в 3 раза частоты новых случаев диабета (относительный риск 0,43). Применение хронотерапии при АГ и коморбидных заболеваниях является дополнительным методом оптимизации фармакотерапии, безопасным для клинической практики. Ключевые слова: артериальная гипертония, суточное мониторирование артериального давления, суточный профиль артериального давления, сердечно-сосудистые исходы, хроническая болезнь почек, сахарный диабет.
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Abstract Arterial hypertension (AH) chronotherapy includes using antihypertensive medications (AHM) in evenings that is especially rational in patients with disturbed daily rhythm of blood pressure (BP) changes (non-dipping, reverse dipping). Chronotherapy use results in increase of hypotensive therapy effect and normalization of nocturnal BP dipping as well as cardiovascular risk reduction. In large prospective studies (МАРЕС, n=3344, Hygia Chronotherapy Trial, n=19 084) intake of ≥1 medication in the evening resulted in significant additional decrease of all cardiovascular events by 61% and 45%, respectively. In chronotherapy evaluation for different AHM groups the best effect was seen in renin-angiotensin-aldosterone system antagonists (angiotensine transforming enzyme inhibitors, angiotensin II receptor blockers) and calcium antagonists. Chronotherapy advantages were shown in elderly patients, patients with resistant AH, and comorbid chronic renal disease and diabetes mellitus. According to randomized clinical studies results and metaanalyses in patients with AH and chronic renal disease intake of AHM in the evening resulted in normalization of 24-hour BP profile and achievement of renoprotective effect (proteinuria decrease, glomerular filtration rate increase), as well as in decrease of relative risk of cardiovascular outcomes almost by 70%. In МАРЕС study in patients with AH and diabetes mellitus evening intake of AHM also resulted in 24-hour BP profile normalization and significant decrease of risks by almost 70%. Apart from that, in patients without history of diabetes after chronotherapy use with evening intake of AHM apart from betel BP level control, three-fold decrease in diabetes mellitus incidence was observed (relative risk 0.43). Chronotherapy use in AH and comorbid disorders is an additional method of pharmacotherapy optimization that is safe for use in clinical practice.
1. Parati G, Stergiou G, O'Brien E et al; European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014; 32 (7): 1359–66. DOI:10.1097/HJH.0000000000000221 2. Kario K, Shimada K. Risers and extreme-dippers of nocturnal blood pressure in hypertension: antihypertensive strategy for nocturnal blood pressure. Clin Exp Hypertens 2004; 26 (2): 177–89. DOI:10.1081/ceh-120028556 3. Salles GF, Reboldi G, Fagard RH et al; ABC-H Investigators. Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis. Hypertension 2016; 67 (4): 693–700. DOI:10.1161/HYPERTENSIONAHA.115.06981 4. Hermida RC, Smolensky MH. Chronotherapy of hypertension. Curr Opin Nephrol Hypertens 2004; 13: 501–5. DOI: 10.1097/00041552-200409000-00004 5. Hermida RC, Ayala DE, Fernández JR et al. Аdministration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. Chronobiol Int 2013; 30 (1–2): 280–314. DOI: 10.3109/07420528.2012.709448 6. Smolensky MH, Hermida RC, Ayala DE et al. Administration-time-dependent effects of blood pressurelowering medications: basis for the chronotherapy of hypertension. Blood Press Monit 2010; 15 (4): 173–80. DOI: 10.1097/MBP.0b013e32833c7308 7. Hermida RC, Ayala DE, Mojón A, Fernández JR. Influence of circadian time of hypertension treatment on cardiovascular risk: Results of the MAPEC study. Chronobiol Int 2010; 27: 1629–51. DOI:10.3109/07420528.2010.510230 8. Hermida RC, Ayala DE, Fernández JR, Mojón A. Sleep-time blood pressure: prognostic value and relevance as a therapeutic target for cardiovascular risk reduction. Chronobiol Int 2013; 30 (1–2): 68–86. DOI: 10.3109/07420528.2012.702581 9. Hermida RC, Ayala DE, Crespo JJ et al. Influence of age and hypertension treatment-time on ambulatory blood pressure in hypertensive patients. Chronobiol Int 2013; 30 (1–2): 176–91. DOI:10.3109/07420528.2012.701131 10. Ayala DE, Hermida RC, Mojón A, Fernández JR. Cardiovascular risk of resistant hypertension: dependence on treatment-time regimen of blood pressure-lowering medications. Chronobiol Int 2013; 30 (1–2): 340–52. DOI: 10.3109/07420528.2012.701455 11. Hermida RC, Crespo JJ, Domínguez-Sardiña M et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J 2019. DOI:10.1093/eurheartj/ehz754 [Epub ahead of print] 12. Agarwal R. Ambulatory blood pressure and cardiovascular events in chronic kidney disease. Semin Nephrol 2007; 27 (5): 538–43. DOI: 10.1016/j.semnephrol.2007.07.001 13. Fedecostante M, Spannella F, Cola G et al. Chronic kidney disease is characterized by "double trouble" higher pulse pressure plus night-time systolic blood pressure and more severe cardiac damage. PLoS One 2014; 9 (1): e86155. DOI:10.1371/journal.pone.0086155 14. Koopman MG, Koomen GC, Krediet RT et al. Circadian rhythm of glomerular filtration rate in normal individuals. Clin Sci (Lond) 1989; 77 (1): 105–11. DOI: 10.1042/cs0770105 15. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in chronic kidney disease. J Am Soc Nephrol 2011; 22: 2313–21. DOI:10.1681/ASN.2011040361 16. Crespo JJ, Piñeiro L, Otero A et al; Hygia Project Investigators. Administration-time-dependent effects of hypertension treatment on ambulatory blood pressure in patients with chronic kidney disease. Chronobiol Int 2013; 30 (1–2): 159–75. DOI: 10.3109/07420528.2012.701459 17. Minutolo R, Gabbai FB, Borrelli S et al. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. Am J Kidney Dis 2007; 50 (6): 908–17. DOI: 10.1053/j.ajkd.2007.07.020 18. Liu X, Liu X, Huang W et al. Evening -versus morning- dosing drug therapy for chronic kidney disease patients with hypertension: a systematic review. Kidney Blood Press Res 2014; 39 (5): 427–40. DOI: 10.1159/000368456 19. Wang C, Ye Y, Liu C et al. Evening versus morning dosing regimen drug therapy for chronic kidney disease patients with hypertension in blood pressure patterns: a systematic review and meta-analysis. Intern Med J 2017; 47 (8): 900–6. DOI: 10.1007/s11255-016-1437-2 20. Cachofeiro V, Goicochea M, de Vinuesa SG et al. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney Int 2008; 74 (Suppl. 111): S4–S9. DOI:10.1038/ki.2008.516 21. Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet 2012; 380 (9841): 601–10. DOI: 10.1016/S0140-6736(12)60987-8 22. Palmas W, Pickering T, Teresi J et al. Nocturnal blood pressure elevation predicts progression of albuminuria in elderly people with type 2 diabetes. J Clin Hypertens (Greenwich) 2008; 10: 12–20. DOI: 10.1111/j.1524-6175.2007.07170.x 23. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of time of day of blood pressure-lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care 2011; 34: 1270–6. DOI: 10.2337/dc11-0297 24. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial. Diabetologia 2016; 59 (2): 255–65. DOI: 10.1007/s00125-015-3749-7 25. Moyá A, Crespo JJ, Ayala DE et al; Hygia Project Investigators. Effects of time-of-day of hypertension treatment on ambulatory blood pressure and clinical characteristics of patients with type 2 diabetes. Chronobiol Int 2013; 30 (1–2): 116–31. DOI: 10.3109/07420528.2012.702587 26. Standards of medical care in diabetes – 2014. Diabetes Care 2014; 37 (Suppl. 1): S14–S80. DOI:10.2337/dc14-S014
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1. Parati G, Stergiou G, O'Brien E et al; European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014; 32 (7): 1359–66. DOI:10.1097/HJH.0000000000000221 2. Kario K, Shimada K. Risers and extreme-dippers of nocturnal blood pressure in hypertension: antihypertensive strategy for nocturnal blood pressure. Clin Exp Hypertens 2004; 26 (2): 177–89. DOI:10.1081/ceh-120028556 3. Salles GF, Reboldi G, Fagard RH et al; ABC-H Investigators. Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis. Hypertension 2016; 67 (4): 693–700. DOI:10.1161/HYPERTENSIONAHA.115.06981 4. Hermida RC, Smolensky MH. Chronotherapy of hypertension. Curr Opin Nephrol Hypertens 2004; 13: 501–5. DOI: 10.1097/00041552-200409000-00004 5. Hermida RC, Ayala DE, Fernández JR et al. Аdministration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. Chronobiol Int 2013; 30 (1–2): 280–314. DOI: 10.3109/07420528.2012.709448 6. Smolensky MH, Hermida RC, Ayala DE et al. Administration-time-dependent effects of blood pressurelowering medications: basis for the chronotherapy of hypertension. Blood Press Monit 2010; 15 (4): 173–80. DOI: 10.1097/MBP.0b013e32833c7308 7. Hermida RC, Ayala DE, Mojón A, Fernández JR. Influence of circadian time of hypertension treatment on cardiovascular risk: Results of the MAPEC study. Chronobiol Int 2010; 27: 1629–51. DOI:10.3109/07420528.2010.510230 8. Hermida RC, Ayala DE, Fernández JR, Mojón A. Sleep-time blood pressure: prognostic value and relevance as a therapeutic target for cardiovascular risk reduction. Chronobiol Int 2013; 30 (1–2): 68–86. DOI: 10.3109/07420528.2012.702581 9. Hermida RC, Ayala DE, Crespo JJ et al. Influence of age and hypertension treatment-time on ambulatory blood pressure in hypertensive patients. Chronobiol Int 2013; 30 (1–2): 176–91. DOI:10.3109/07420528.2012.701131 10. Ayala DE, Hermida RC, Mojón A, Fernández JR. Cardiovascular risk of resistant hypertension: dependence on treatment-time regimen of blood pressure-lowering medications. Chronobiol Int 2013; 30 (1–2): 340–52. DOI: 10.3109/07420528.2012.701455 11. Hermida RC, Crespo JJ, Domínguez-Sardiña M et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J 2019. DOI:10.1093/eurheartj/ehz754 [Epub ahead of print] 12. Agarwal R. Ambulatory blood pressure and cardiovascular events in chronic kidney disease. Semin Nephrol 2007; 27 (5): 538–43. DOI: 10.1016/j.semnephrol.2007.07.001 13. Fedecostante M, Spannella F, Cola G et al. Chronic kidney disease is characterized by "double trouble" higher pulse pressure plus night-time systolic blood pressure and more severe cardiac damage. PLoS One 2014; 9 (1): e86155. DOI:10.1371/journal.pone.0086155 14. Koopman MG, Koomen GC, Krediet RT et al. Circadian rhythm of glomerular filtration rate in normal individuals. Clin Sci (Lond) 1989; 77 (1): 105–11. DOI: 10.1042/cs0770105 15. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in chronic kidney disease. J Am Soc Nephrol 2011; 22: 2313–21. DOI:10.1681/ASN.2011040361 16. Crespo JJ, Piñeiro L, Otero A et al; Hygia Project Investigators. Administration-time-dependent effects of hypertension treatment on ambulatory blood pressure in patients with chronic kidney disease. Chronobiol Int 2013; 30 (1–2): 159–75. DOI: 10.3109/07420528.2012.701459 17. Minutolo R, Gabbai FB, Borrelli S et al. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. Am J Kidney Dis 2007; 50 (6): 908–17. DOI: 10.1053/j.ajkd.2007.07.020 18. Liu X, Liu X, Huang W et al. Evening -versus morning- dosing drug therapy for chronic kidney disease patients with hypertension: a systematic review. Kidney Blood Press Res 2014; 39 (5): 427–40. DOI: 10.1159/000368456 19. Wang C, Ye Y, Liu C et al. Evening versus morning dosing regimen drug therapy for chronic kidney disease patients with hypertension in blood pressure patterns: a systematic review and meta-analysis. Intern Med J 2017; 47 (8): 900–6. DOI: 10.1007/s11255-016-1437-2 20. Cachofeiro V, Goicochea M, de Vinuesa SG et al. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney Int 2008; 74 (Suppl. 111): S4–S9. DOI:10.1038/ki.2008.516 21. Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet 2012; 380 (9841): 601–10. DOI: 10.1016/S0140-6736(12)60987-8 22. Palmas W, Pickering T, Teresi J et al. Nocturnal blood pressure elevation predicts progression of albuminuria in elderly people with type 2 diabetes. J Clin Hypertens (Greenwich) 2008; 10: 12–20. DOI: 10.1111/j.1524-6175.2007.07170.x 23. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of time of day of blood pressure-lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care 2011; 34: 1270–6. DOI: 10.2337/dc11-0297 24. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial. Diabetologia 2016; 59 (2): 255–65. DOI: 10.1007/s00125-015-3749-7 25. Moyá A, Crespo JJ, Ayala DE et al; Hygia Project Investigators. Effects of time-of-day of hypertension treatment on ambulatory blood pressure and clinical characteristics of patients with type 2 diabetes. Chronobiol Int 2013; 30 (1–2): 116–31. DOI: 10.3109/07420528.2012.702587 26. Standards of medical care in diabetes – 2014. Diabetes Care 2014; 37 (Suppl. 1): S14–S80. DOI:10.2337/dc14-S014
Авторы
М.В. Леонова*
Межрегиональная общественная организация «Ассоциация клинических фармакологов России» *anti23@mail.ru
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Marina V. Leonova* Interregional Public Organization "Russian Association of Clinical Pharmacologists" *anti23@mail.ru