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Wu C, Zhao P, Xu P, Wan C, Singh S, Varthya SB, Luo SH. Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev 2024; 2:CD004184. [PMID: 38353289 PMCID: PMC10865448 DOI: 10.1002/14651858.cd004184.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Variation in blood pressure levels display circadian rhythms. Complete 24-hour blood pressure control is the primary goal of antihypertensive treatment and reducing adverse cardiovascular outcomes is the ultimate aim. This is an update of the review first published in 2011. OBJECTIVES To evaluate the effectiveness of administration-time-related effects of once-daily evening versus conventional morning dosing antihypertensive drug therapy regimens on all-cause mortality, cardiovascular mortality and morbidity, total adverse events, withdrawals from treatment due to adverse effects, and reduction of systolic and diastolic blood pressure in people with primary hypertension. SEARCH METHODS We searched the Cochrane Hypertension Specialised Register via Cochrane Register of Studies (17 June 2022), Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2022); MEDLINE, MEDLINE In-Process and MEDLINE Epub Ahead of Print (1 June 2022); Embase (1 June 2022); ClinicalTrials.gov (2 June 2022); Chinese Biomedical Literature Database (CBLD) (1978 to 2009); Chinese VIP (2009 to 7 August 2022); Chinese WANFANG DATA (2009 to 4 August 2022); China Academic Journal Network Publishing Database (CAJD) (2009 to 6 August 2022); Epistemonikos (3 September 2022) and the reference lists of relevant articles. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing the administration-time-related effects of evening with morning dosing monotherapy regimens in people with primary hypertension. We excluded people with known secondary hypertension, shift workers or people with white coat hypertension. DATA COLLECTION AND ANALYSIS Two to four review authors independently extracted data and assessed trial quality. We resolved disagreements by discussion or with another review author. We performed data synthesis and analyses using Review Manager Web for all-cause mortality, cardiovascular mortality and morbidity, serious adverse events, overall adverse events, withdrawals due to adverse events, change in 24-hour blood pressure and change in morning blood pressure. We assessed the certainty of the evidence using GRADE. We conducted random-effects meta-analysis, fixed-effect meta-analysis, subgroup analysis and sensitivity analysis. MAIN RESULTS We included 27 RCTs in this updated review, of which two RCTs were excluded from the meta-analyses for lack of data and number of groups not reported. The quantitative analysis included 25 RCTs with 3016 participants with primary hypertension. RCTs used angiotensin-converting enzyme inhibitors (six trials), calcium channel blockers (nine trials), angiotensin II receptor blockers (seven trials), diuretics (two trials), α-blockers (one trial), and β-blockers (one trial). Fifteen trials were parallel designed, and 10 trials were cross-over designed. Most participants were white, and only two RCTs were conducted in Asia (China) and one in Africa (South Africa). All trials excluded people with risk factors of myocardial infarction and strokes. Most trials had high risk or unclear risk of bias in at least two of several key criteria, which was most prominent in allocation concealment (selection bias) and selective reporting (reporting bias). Meta-analysis showed significant heterogeneity across trials. No RCTs reported on cardiovascular mortality and cardiovascular morbidity. There may be little to no differences in all-cause mortality (after 26 weeks of active treatment: RR 0.49, 95% CI 0.04 to 5.42; RD 0, 95% CI -0.01 to 0.01; very low-certainty evidence), serious adverse events (after 8 to 26 weeks of active treatment: RR 1.17, 95% CI 0.53 to 2.57; RD 0, 95% CI -0.02 to 0.03; very low-certainty evidence), overall adverse events (after 6 to 26 weeks of active treatment: RR 0.89, 95% CI 0.67 to 1.20; I² = 37%; RD -0.02, 95% CI -0.07 to 0.02; I² = 38%; very low-certainty evidence) and withdrawals due to adverse events (after 6 to 26 weeks active treatment: RR 0.76, 95% CI 0.47 to 1.23; I² = 0%; RD -0.01, 95% CI -0.03 to 0; I² = 0%; very low-certainty evidence), but the evidence was very uncertain. AUTHORS' CONCLUSIONS Due to the very limited data and the defects of the trials' designs, this systematic review did not find adequate evidence to determine which time dosing drug therapy regimen has more beneficial effects on cardiovascular outcomes or adverse events. We have very little confidence in the evidence showing that evening dosing of antihypertensive drugs is no more or less effective than morning administration to lower 24-hour blood pressure. The conclusions should not be assumed to apply to people receiving multiple antihypertensive drug regimens.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Zhao
- Medical Library, Sichuan University, Chengdu, China
| | - Ping Xu
- Medical Library, Sichuan University, Chengdu, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Surjit Singh
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shoban Babu Varthya
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shuang-Hong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Chakraborty S, Kannihalli A, Mohanty A, Ray S. The Promises of Proteomics and Metabolomics for Unravelling the Mechanism and Side Effect Landscape of Beta-Adrenoceptor Antagonists in Cardiovascular Therapeutics. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2023; 27:87-92. [PMID: 36854142 DOI: 10.1089/omi.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Cardiovascular medicine witnessed notable advances for the past decade. Multiomics research offers a new lens for precision/personalized medicine for existing and emerging drugs used in the cardiovascular clinic. Beta-blockers are vital in treating hypertension and chronic heart failure. However, clinical use of beta-blockers is also associated with side effects and person-to-person variations in their pharmacokinetics and pharmacodynamics. A comprehensive understanding of the mechanisms that underpin the side effect landscape of beta-blockers is imperative to optimize their therapeutic value. In addition, current research emphasizes the circadian clock's vital roles in regulating pharmacological parameters. Administration of the beta-blockers at specific dosing times could potentially improve their effectiveness and reduce their toxic effects. The rapid development of mass spectrometry technologies with chemical proteomics and thermal proteome profiling methods has also substantially advanced our understanding of underlying side effects mechanisms by unbiased deconvolution of drug targets and off-targets. Metabolomics is steadily demonstrating its utility for conducting mechanistic and toxicological analyses of pharmacological compounds. This article discusses the promises of cutting-edge proteomics and metabolomics approaches to investigate the molecular targets, mechanism of action, adverse effects, and dosing time dependency of beta-blockers.
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Affiliation(s)
| | - Arpita Kannihalli
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Sangareddy, India
| | - Abhishek Mohanty
- Cardiology Department, Continental Hospitals, Nanakaramguda, India
| | - Sandipan Ray
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Sangareddy, India
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Joshi K, Das M, Sarma A, Arora MK, SInghal M, Kumar B. Insight on Cardiac Chronobiology and Latest Developments of Chronotherapeutic Antihypertensive Interventions for Better Clinical Outcomes. Curr Hypertens Rev 2023; 19:106-122. [PMID: 36624649 DOI: 10.2174/1573402119666230109142156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 01/11/2023]
Abstract
Cardiac circadian rhythms are an important regulator of body functions, including cardiac activities and blood pressure. Disturbance of circadian rhythm is known to trigger and aggravate various cardiovascular diseases. Thus, modulating the circadian rhythm can be used as a therapeutic approach to cardiovascular diseases. Through this work, we intend to discuss the current understanding of cardiac circadian rhythms, in terms of quantifiable parameters like BP and HR. We also elaborate on the molecular regulators and the molecular cascades along with their specific genetic aspects involved in modulating circadian rhythms, with specific reference to cardiovascular health and cardiovascular diseases. Along with this, we also presented the latest pharmacogenomic and metabolomics markers involved in chronobiological control of the cardiovascular system along with their possible utility in cardiovascular disease diagnosis and therapeutics. Finally, we reviewed the current expert opinions on chronotherapeutic approaches for utilizing the conventional as well as the new pharmacological molecules for antihypertensive chronotherapy.
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Affiliation(s)
- Kumud Joshi
- Department of Pharmacy, Lloyd Institute of Management and Technology, Greater Noida, India
| | - Madhubanti Das
- Department of Zoology, Gauhati University, Guwahati, Assam, India
| | - Anupam Sarma
- Advanced Drug Delivery Laboratory, GIPS, Girijananda Chowdhury University, Guwahati, Assam, India
| | - Mandeep K Arora
- School of Pharmacy and population health informatics, DIT University, Dehradun, India
| | - Manmohan SInghal
- School of Pharmacy and population health informatics, DIT University, Dehradun, India
| | - Bhavna Kumar
- School of Pharmacy and population health informatics, DIT University, Dehradun, India
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Xie Z, Zhang J, Wang C, Yan X. Chronotherapy for morning blood pressure surge in hypertensive patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 2021; 21:274. [PMID: 34088274 PMCID: PMC8176711 DOI: 10.1186/s12872-021-02081-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The morning blood pressure surge (MBPS) is related to an exaggerated risk of cardiovascular diseases and mortality. With increasing attention on circadian change in blood pressure and extensive use of ambulatory blood pressure monitoring (ABPM), chronotherapy that administration of medication according to biological rhythm, is reported to improve cardiovascular outcomes. The aim of this study is to evaluate the influence of chronotherapy of antihypertensive drugs upon MBPS in hypertensive patients. METHODS A search strategy was applied in Ovid MEDLINE, EMBASE, Cochrane (Wiley) CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the Chinese Biomedical literature database. No language and date restrictions. Randomized controlled trials (RCT) assessing the efficacy of evening and morning administration of the same medications in adult patients with primary hypertension were included. RESULTS A total of ten trials, comprising 1724 participants with a mean age of 61 and 51% female, were included in this study. Combined analysis observed significant reduction of MBPS (- 5.30 mmHg, 95% CI - 8.80 to - 1.80), night-time SBP (- 2.29 mmHg, 95% CI - 4.43 to - 0.15), night-time DBP (- 1.63 mmHg, 95 %CI - 3.23 to - 0.04) and increase in night blood pressure dipping (3.23%, 95% CI 5.37 to 1.10) in evening dosage compared with traditional morning dosage of blood pressure-lowering drugs. No significant difference was found in the incidence of overall adverse effects (RR 0.65, 95% CI 0.30 to 1.41) and withdrawal due to adverse effects (RR 0.95, 95% CI 0.53 to 1.71). CONCLUSIONS Our study suggested that evening administration of antihypertensive medications exerted better blood pressure-lowering effect on MBPS compared with conventional morning dosage. Safety assessment also indicated that the evening regimen did not increase the risk of adverse events. However, endpoint studies need to be carried out to confirm the significance and feasibility of this treatment regimen in clinical practice.
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Affiliation(s)
- Ziyan Xie
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1 ShuaiFuYuan, Beijing, 100730, China
| | - Jiahao Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1 ShuaiFuYuan, Beijing, 100730, China
| | - Chenyu Wang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1 ShuaiFuYuan, Beijing, 100730, China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No.1 ShuaiFuYuan, Beijing, 100730, China.
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Lopuszko A, Patrick Tan SZC, Munir W, Bashir M. Aortic aneurysm disease-Make room for chronobiology. J Card Surg 2021; 36:2496-2501. [PMID: 33797793 DOI: 10.1111/jocs.15548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aortic aneurysm (AA) is a common atherosclerotic condition, accounting for nearly 6000 deaths in England and up to 175,000 deaths globally each year. The pathological outward bulging of the aorta typically results from atherosclerosis or hereditary connective tissue disorders. AAs are usually asymptomatic until spontaneous rupture or detected on incidental screening. Eight in 10 patients do not survive the rupture and die either before reaching hospital or from complications following surgery. Similar to other cardiovascular pathologies, AA is thought to be subject to chronobiological patterns of varying incidence. METHODS We performed a literature review of the current literature to evaluate the association between circadian rhythms, seasonal variations, and genetic factors and the pathogenesis of AA, reviewing the impact of chronobiology. RESULTS The incidence of AA is found to peak in the early morning (6-11 a.m.) and colder months, and conversely troughs towards the evening and warmer months, exhibiting a similar pattern of chronobiological rhythm as other cerebrovascular pathologies, such as myocardial infarcts, or cerebrovascular strokes. CONCLUSION Literature suggests there exists a clear relationship between chronobiology and the incidence and pathogenesis of ruptured AA; incidence increases in the morning (6-11 a.m.), and during colder months (December-January). This is more pronounced in patients with Marfan syndrome, or vitamin D deficiency. The underlying pathophysiology and implications this has for chronotherapeutics, are also discussed. Our review shows a clear need for further research into the chronotherapeutic approach to preventing ruptured AA in the journey towards precision medicine.
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Affiliation(s)
- Aleksandra Lopuszko
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sven Zhen Cian Patrick Tan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Wahaj Munir
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mohamad Bashir
- Vascular Surgery Department, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom
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Hermida RC, Mojón A, Hermida-Ayala RG, Smolensky MH, Fernández JR. Extent of asleep blood pressure reduction by hypertension medications is ingestion-time dependent: Systematic review and meta-analysis of published human trials. Sleep Med Rev 2021; 59:101454. [PMID: 33571840 DOI: 10.1016/j.smrv.2021.101454] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
Combined evidence of published prospective outcome trials and meta-analyses substantiate elevated asleep blood pressure (BP) and blunted sleep-time relative BP decline (non-dipping), regardless of wake-time office BP and awake or 24 h BP means, are jointly the most highly significant independent prognostic markers of cardiovascular disease (CVD) risk and worthy therapeutic targets for prevention. Nonetheless, current guidelines continue to recommend the diagnosis of hypertension, when based on ambulatory BP monitoring (ABPM), rely, solely, on either the 24 h or "daytime" BP means. They also fail to recommend the time to treat patients. We conducted a systematic review of published human trials regarding ingestion-time differences in the effects of hypertension medications on asleep BP and sleep-time relative BP decline. Some 62 such trials published between 1992 and 2020, totaling 6120 hypertensive persons, evaluated 21 different single and 8 dual-fixed combination therapies. The vast (82.3%) majority of the trials substantiate the bedtime/evening vs. upon-waking/morning treatment schedule produces statistically significant better clinical benefits, including enhanced reduction of asleep systolic BP by an average 5.17 mmHg (95%CI [4.04, 6.31], P < 0.001 between treatment-time groups) without inducing sleep-time hypotension, reduced prevalence of the high CVD risk non-dipper 24 h BP pattern, improved kidney function, and reduced cardiac pathology. Furthermore, systematic and comprehensive review of the ABPM-based literature published the past 29 years reveals no single study that reported significantly better benefits of the most recommended, yet unjustified by medical evidence, morning hypertension treatment-time scheme.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain; Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA.
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain
| | - Ramón G Hermida-Ayala
- Chief Pharmacology Officer, Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, 15703, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain
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Walton JC, Walker WH, Bumgarner JR, Meléndez-Fernández OH, Liu JA, Hughes HL, Kaper AL, Nelson RJ. Circadian Variation in Efficacy of Medications. Clin Pharmacol Ther 2020; 109:1457-1488. [PMID: 33025623 DOI: 10.1002/cpt.2073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/13/2020] [Indexed: 12/22/2022]
Abstract
Although much has been learned about circadian clocks and rhythms over the past few decades, translation of this foundational science underlying the temporal regulation of physiology and behavior to clinical applications has been slow. Indeed, acceptance of the modern study of circadian rhythms has been blunted because the phenomenology of cyclic changes had to counteract the 20th century dogma of homeostasis in the biological sciences and medicine. We are providing this review of clinical data to highlight the emerging awareness of circadian variation in efficacy of medications for physicians, clinicians, and pharmacists. We are suggesting that gold-standard double-blind clinical studies should be conducted to determine the best time of day for optimal effectiveness of medications; also, we suggest that time of day should be tracked and reported as an important biological variable in ongoing clinical studies hereafter. Furthermore, we emphasize that time of day is, and should be considered, a key biological variable in research design similar to sex. In common with biomedical research data that have been historically strongly skewed toward the male sex, most pharmaceutical data have been skewed toward morning dosing without strong evidence that this is the optimal time of efficacy.
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Affiliation(s)
- James C Walton
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - William H Walker
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Jacob R Bumgarner
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - O Hecmarie Meléndez-Fernández
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Jennifer A Liu
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Heather L Hughes
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Alexis L Kaper
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Randy J Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
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Zhou Z, Yuan J, Zhu D, Chen Y, Qian Z, Wang Y, Ge P, Wang Q, Hou X, Zou J. CLOCK-BMAL1 regulates circadian oscillation of ventricular arrhythmias in failing hearts through β1 adrenergic receptor. Am J Transl Res 2020; 12:6122-6135. [PMID: 33194018 PMCID: PMC7653582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
The incidence of ventricular arrhythmias (VAs) in chronic heart failure (CHF) exhibits a notable circadian rhythm, for which the underlying mechanism has not yet been well defined. Thus, we aimed to investigate the role of cardiac core circadian genes on circadian VAs in CHF. First, a guinea pig CHF model was created by transaortic constriction. Circadian oscillation of core clock genes was evaluated by RT-PCR and was found to be unaltered in CHF (P > 0.05). Using programmed electrical stimulation in Langendorff-perfused failing hearts, we discovered that the CHF group exhibited increased VAs with greater incidence at CT3 compared to CT15 upon isoproterenol (ISO) stimulation. Circadian VAs was blunted by a β1-AR-selective blocker rather than a β2-AR-selective blocker. Circadian oscillation of β1-AR was retained in CHF (P > 0.05) and a 4-h phase delay between β1-AR and CLOCK-BMAL1 was recorded. Therefore, when CLOCK-BMAL1 was overexpressed using adenovirus infection, an induced overexpression of β1-AR also ensued, which resulted in prolonged action potential duration (APD) and enhanced arrhythmic response to ISO stimulation in cardiomyocytes (P < 0.05). Finally, chromatin immunoprecipitation and luciferase assays confirmed that CLOCK-BMAL1 binds to the enhancer of β1-AR gene and upregulates β1-AR expression. Therefore, in this study, we discovered that CLOCK-BMAL1 regulates the expression of β1-AR on a transcriptional level and subsequently modulates circadian VAs in CHF.
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Affiliation(s)
- Zihao Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
| | - Jiamin Yuan
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
- Department of Cardiology, The First Affiliated Hospital of Soochow UniversitySuzhou, Jiangsu, China
| | - Didi Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
- Department of Cardiology, Zhongda HospitalNanjing, Jiangsu, China
| | - Yanhong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
| | - Peibin Ge
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
| | - Quanpeng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, China
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Re CJ, Batterman AI, Gerstner JR, Buono RJ, Ferraro TN. The Molecular Genetic Interaction Between Circadian Rhythms and Susceptibility to Seizures and Epilepsy. Front Neurol 2020; 11:520. [PMID: 32714261 PMCID: PMC7344275 DOI: 10.3389/fneur.2020.00520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022] Open
Abstract
Seizure patterns observed in patients with epilepsy suggest that circadian rhythms and sleep/wake mechanisms play some role in the disease. This review addresses key topics in the relationship between circadian rhythms and seizures in epilepsy. We present basic information on circadian biology, but focus on research studying the influence of both the time of day and the sleep/wake cycle as independent but related factors on the expression of seizures in epilepsy. We review studies investigating how seizures and epilepsy disrupt expression of core clock genes, and how disruption of clock mechanisms impacts seizures and the development of epilepsy. We focus on the overlap between mechanisms of circadian-associated changes in SCN neuronal excitability and mechanisms of epileptogenesis as a means of identifying key pathways and molecules that could represent new targets or strategies for epilepsy therapy. Finally, we review the concept of chronotherapy and provide a perspective regarding its application to patients with epilepsy based on their individual characteristics (i.e., being a “morning person” or a “night owl”). We conclude that better understanding of the relationship between circadian rhythms, neuronal excitability, and seizures will allow both the identification of new therapeutic targets for treating epilepsy as well as more effective treatment regimens using currently available pharmacological and non-pharmacological strategies.
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Affiliation(s)
- Christopher J Re
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Alexander I Batterman
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Jason R Gerstner
- Department of Biomedical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Russell J Buono
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Thomas N Ferraro
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
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Soares AC, Fonseca DA. Cardiovascular diseases: a therapeutic perspective around the clock. Drug Discov Today 2020; 25:1086-1098. [PMID: 32320853 DOI: 10.1016/j.drudis.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 01/21/2023]
Abstract
Biological rhythms are a ubiquitous feature of life. Most bodily functions, including physiological, biochemical, and behavioral processes, are coupled by the circadian rhythm. In the cardiovascular system, circadian fluctuations regulate several functions, namely heart rate, blood pressure, cardiac contractility, and metabolism. In fact, current lifestyles impose external timing constraints that clash with our internal circadian physiology, often increasing the risk of cardiovascular disease (CVD). Still, the mechanisms of dysregulation are not fully understood because this is a growing area of research. In this review, we explore the modulatory role of the circadian rhythms on cardiovascular function and disease as well as the role of chronotherapy in the context of CVD and how such an approach could improve existing therapies and assist in the development of new ones.
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Affiliation(s)
| | - Diogo A Fonseca
- Laboratory of Pharmacology and Pharmaceutical Care, Faculty of Pharmacy, University of Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal; CIBB Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Portugal.
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11
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Blood Pressure Variability and Therapeutic Implications in Hypertension and Cardiovascular Diseases. High Blood Press Cardiovasc Prev 2019; 26:353-359. [PMID: 31559570 PMCID: PMC6825020 DOI: 10.1007/s40292-019-00339-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/31/2019] [Indexed: 12/18/2022] Open
Abstract
Blood pressure (BP) is characterized by continuous dynamic and spontaneous oscillations occurring over lifetime and defining the so-called blood pressure variability (BPV). BPV has been associated with target organ damage, cardiovascular (CV) risk and death, suggesting the use of BPV as a new target in hypertension management in addition to mean BP values lowering. The purpose of the review is to focus on the therapeutic implications of BPV and summarize the effects of different drug classes on various types of BPV. Despite most first-line antihypertensive medications contribute to reduce both short and long term BPV, calcium channel blockers (CCBs) as monotherapy or fixed-combination therapy appear to be the most effective on BPV control. Further randomized interventional trials are needed to investigate which drug combinations are most appropriate according to patient CV risk stratification, in order to improve their CV outcomes.
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12
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Autonomic nerves and circadian control of renal function. Auton Neurosci 2019; 217:58-65. [PMID: 30704976 DOI: 10.1016/j.autneu.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
Abstract
Cardiovascular and renal physiology follow strong circadian rhythms. For instance, renal excretion of solutes and water is higher during the active period compared to the inactive period, and blood pressure peaks early in the beginning of the active period of both diurnal and nocturnal animals. The control of these rhythms is largely dependent on the expression of clock genes both in the central nervous system and within peripheral organs themselves. Although it is understood that the central and peripheral clocks interact and communicate, few studies have explored the specific mechanism by which various organ systems within the body are coordinated to control physiological processes. The renal sympathetic nervous innervation has long been known to have profound effects on renal function, and because the sympathetic nervous system follows strong circadian rhythms, it is likely that autonomic control of the kidney plays an integral role in modulating renal circadian function. This review highlights studies that provide insight into this interaction, discusses areas lacking clarity, and suggests the potential for future work to explore the role of renal autonomics in areas such as blood pressure control and chronic kidney disease.
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Bilo G, Grillo A, Guida V, Parati G. Morning blood pressure surge: pathophysiology, clinical relevance and therapeutic aspects. Integr Blood Press Control 2018; 11:47-56. [PMID: 29872338 PMCID: PMC5973439 DOI: 10.2147/ibpc.s130277] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Morning hours are the period of the day characterized by the highest incidence of major cardiovascular events including myocardial infarction, sudden death or stroke. They are also characterized by important neurohormonal changes, in particular, the activation of sympathetic nervous system which usually leads to a rapid increase in blood pressure (BP), known as morning blood pressure surge (MBPS). It was hypothesized that excessive MBPS may be causally involved in the pathogenesis of cardiovascular events occurring in the morning by inducing hemodynamic stress. A number of studies support an independent relationship of MBPS with organ damage, cerebrovascular complications and mortality, although some heterogeneity exists in the available evidence. This may be due to ethnic differences, methodological issues and the confounding relationship of MBPS with other features of 24-hour BP profile, such as nocturnal dipping or BP variability. Several studies are also available dealing with treatment effects on MBPS and indicating the importance of long-acting antihypertensive drugs in this regard. This paper provides an overview of pathophysiologic, methodological, prognostic and therapeutic aspects related to MBPS.
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Affiliation(s)
- Grzegorz Bilo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Grillo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Valentina Guida
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Zhang D, Pollock DM. Circadian regulation of kidney function: finding a role for Bmal1. Am J Physiol Renal Physiol 2018; 314:F675-F678. [PMID: 29357439 PMCID: PMC6031908 DOI: 10.1152/ajprenal.00580.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/28/2023] Open
Abstract
Mounting evidence suggests that there is an internal molecular "clock" within the kidney to help maintain normal renal function. Disturbance of the kidney circadian rhythm may pose a threat to water and electrolyte homeostasis and blood pressure regulation, among many other problems. The identification of circadian genes facilitated a more comprehensive appreciation of the importance of "keeping the body on time"; however, our knowledge is very limited with regard to how circadian genes regulate kidney function. In this brief review, we summarize recent progress in circadian control of renal physiology, with a particular focus on aryl hydrocarbon receptor nuclear translocator-like protein (Arntl1; also called Bmal1).
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Affiliation(s)
- Dingguo Zhang
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - David M Pollock
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama
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Tsimakouridze EV, Alibhai FJ, Martino TA. Therapeutic applications of circadian rhythms for the cardiovascular system. Front Pharmacol 2015; 6:77. [PMID: 25941487 PMCID: PMC4400861 DOI: 10.3389/fphar.2015.00077] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/26/2015] [Indexed: 01/13/2023] Open
Abstract
The cardiovascular system exhibits dramatic time-of-day dependent rhythms, for example the diurnal variation of heart rate, blood pressure, and timing of onset of adverse cardiovascular events such as heart attack and sudden cardiac death. Over the past decade, the circadian clock mechanism has emerged as a crucial factor regulating these daily fluctuations. Most recently, these studies have led to a growing clinical appreciation that targeting circadian biology offers a novel therapeutic approach toward cardiovascular (and other) diseases. Here we describe leading-edge therapeutic applications of circadian biology including (1) timing of therapy to maximize efficacy in treating heart disease (chronotherapy); (2) novel biomarkers discovered by testing for genomic, proteomic, metabolomic, or other factors at different times of day and night (chronobiomarkers); and (3) novel pharmacologic compounds that target the circadian mechanism with potential clinical applications (new chronobiology drugs). Cardiovascular disease remains a leading cause of death worldwide and new approaches in the management and treatment of heart disease are clearly warranted and can benefit patients clinically.
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Affiliation(s)
- Elena V Tsimakouridze
- Cardiovascular Research Group, Department of Biomedical Sciences, University of Guelph Guelph, ON, Canada
| | - Faisal J Alibhai
- Cardiovascular Research Group, Department of Biomedical Sciences, University of Guelph Guelph, ON, Canada
| | - Tami A Martino
- Cardiovascular Research Group, Department of Biomedical Sciences, University of Guelph Guelph, ON, Canada
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Camargo-Sanchez A, Niño CL, Sánchez L, Echeverri S, Gutiérrez DP, Duque AF, Pianeta O, Jaramillo-Gómez JA, Pilonieta MA, Cataño N, Arboleda H, Agostino PV, Alvarez-Baron CP, Vargas R. Theory of Inpatient Circadian Care (TICC): A Proposal for a Middle-Range Theory. Open Nurs J 2015; 9:1-9. [PMID: 25767632 PMCID: PMC4353124 DOI: 10.2174/1874434601509010001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/22/2014] [Accepted: 01/05/2015] [Indexed: 11/30/2022] Open
Abstract
The circadian system controls the daily rhythms of a variety of physiological processes. Most organisms show physiological, metabolic and behavioral rhythms that are coupled to environmental signals. In humans, the main synchronizer is the light/dark cycle, although non-photic cues such as food availability, noise, and work schedules are also involved. In a continuously operating hospital, the lack of rhythmicity in these elements can alter the patient’s biological rhythms and resilience. This paper presents a Theory of Inpatient Circadian Care (TICC) grounded in circadian principles. We conducted a literature search on biological rhythms, chronobiology, nursing care, and middle-range theories in the databases PubMed, SciELO Public Health, and Google Scholar. The search was performed considering a period of 6 decades from 1950 to 2013. Information was analyzed to look for links between chronobiology concepts and characteristics of inpatient care. TICC aims to integrate multidisciplinary knowledge of biomedical sciences and apply it to clinical practice in a formal way. The conceptual points of this theory are supported by abundant literature related to disease and altered biological rhythms. Our theory will be able to enrich current and future professional practice.
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Affiliation(s)
- Andrés Camargo-Sanchez
- Nursing School at the Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A), Bogotá, Colombia
| | - Carmen L Niño
- Nursing School at the Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A), Bogotá, Colombia
| | - Leonardo Sánchez
- Nursing School at the Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A), Bogotá, Colombia
| | - Sonia Echeverri
- Nursing Department at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | - Diana P Gutiérrez
- Division of Internal Medicine at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | | | - Oscar Pianeta
- School of Medicine at the Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A), Bogotá, Colombia
| | - Jenny A Jaramillo-Gómez
- Cell Death Group, School of Medicine and Institute of Genetics at the Universidad Nacional de Colombia, Bogotá, Colombia
| | - Martin A Pilonieta
- School of Medicine at the Universidad Nacional de Colombia, Bogotá, Colombia
| | - Nhora Cataño
- School of Nursing at the Universidad Nacional de Colombia, Bogotá, Colombia
| | - Humberto Arboleda
- Neurosciences Research Group, School of Medicine and Institute of Genetics at the Universidad Nacional de Colombia, Bogotá, Colombia
| | - Patricia V Agostino
- Laboratorio de Cronobiología, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes/CONICET, Buenos Aires, Argentina
| | | | - Rafael Vargas
- School of Medicine at the Pontificia Universidad Javeriana, Bogotá, Colombia
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Stranges PM, Drew AM, Rafferty P, Shuster JE, Brooks AD. Treatment of hypertension with chronotherapy: is it time of drug administration? Ann Pharmacother 2014; 49:323-34. [PMID: 25515866 DOI: 10.1177/1060028014563535] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To review evidence for dosing antihypertensives at bedtime and possible cardiovascular risk reduction. DATA SOURCES A PubMed, EMBASE, and Cochrane Controlled Trials database literature search (1990-September 2014) limited to human subjects was performed using the search terms hypertension, chronotherapy, ambulatory blood pressure, morning administration, evening administration, and antihypertensives. Additional references were identified from literature citations. STUDY SELECTION All prospective studies assessing cardiovascular outcomes or comparing morning to evening administration of antihypertensives were selected. DATA SYNTHESIS Compared with morning administration, dosing one or more antihypertensive medications at bedtime helps induce a normal circadian blood pressure pattern and reduces the risk of cardiovascular disease morbidity and mortality in individuals with hypertension. Similar results have been reported in high-risk individuals with diabetes, chronic kidney disease, and resistant hypertension. A lack of diversity among studied populations and reliance on subgroup analyses are among the limitations of these data. All antihypertensive medications have not been studied in chronotherapy and do not uniformly achieve desired results. The most substantial evidence exists for medications affecting the renin-angiotensin-aldosterone system. CONCLUSIONS Despite growing evidence and promise as a cost-effective strategy for reducing cardiovascular risk, chronotherapy is not uniformly recommended in the treatment of hypertension. Careful selection of patients and antihypertensives for chronotherapy is required. Further investigation is needed to evaluate the definitive impact of chronotherapy on cardiovascular outcomes.
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Affiliation(s)
- Paul M Stranges
- St Louis College of Pharmacy, MO, USA Barnes-Jewish Hospital Department of Pharmacy, St Louis, MO, USA
| | - Amy M Drew
- St Louis College of Pharmacy, MO, USA Mercy Clinic Family Medicine, St Louis, MO, USA
| | - Patricia Rafferty
- St Louis College of Pharmacy, MO, USA St Louis County Department of Health, MO, USA
| | - Jerrica E Shuster
- St Louis College of Pharmacy, MO, USA Barnes-Jewish Hospital Department of Pharmacy, St Louis, MO, USA
| | - Amie D Brooks
- St Louis College of Pharmacy, MO, USA St Louis County Department of Health, MO, USA
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Borron P, Cohen O, Hoofwijk TJ, Turner JR. Participation of Hypertension Patients in Early-Phase Clinical Trials. J Clin Hypertens (Greenwich) 2014; 16:389-92. [DOI: 10.1111/jch.12296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paul Borron
- Early Clinical Development; Quintiles; Durham NC
| | - Oren Cohen
- Early Clinical Development; Quintiles; Durham NC
| | - Theo J. Hoofwijk
- Therapeutic Strategy Development; Quintiles B.V.; Hoofddorp the Netherlands
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Alexander W. Hypertension: is it time to replace drugs with nutrition and nutraceuticals? P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2014; 39:291-295. [PMID: 24757368 PMCID: PMC3989080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Many hypertension patients want to learn about ways to reduce reliance on pharmaceuticals, says functional medicine practitioner Mark Houston, who believes it is often possible to reduce or eliminate reliance on drugs using nutrition and nutraceuticals.
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Akbar S, Alorainy MS. The current status of beta blockers' use in the management of hypertension. Saudi Med J 2014; 35:1307-17. [PMID: 25399206 PMCID: PMC4362137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The invention of beta (β)-blockers culminated in a new era in the treatment of cardiovascular diseases (CD), and changed the course of pharmacology research for years to come. Since the introduction of propranolol into clinical practice in 1964, β-blockers enjoyed a special place in the clinicians' armamentarium against CDs, especially for patients with ischemic heart diseases, and are still one of the most extensively used therapeutic drugs in both cardiac and non-cardiac ailments. Current uses of β-blockers in CDs include ischemic heart diseases, hypertension, cardiac arrhythmias, and heart failure. Other substantial non-cardiac uses include glaucoma, migraine, situational anxiety, benign essential tremors, and cardiac symptoms of thyrotoxicosis. This review covers some of the evolutionary changes of clinical uses of β-blockers, the rationale for their use, some recent controversies surrounding their use for treatment of hypertension, and advantages of newer additions to the group.
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Affiliation(s)
- Shahid Akbar
- From the Department of Pharmacology and Toxicology (Akbar), College of Pharmacy, and Department of Pharmacology and Therapeutics (Alorainy), College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia.,Address correspondence and reprint request to: Professor Shahid Akbar, Director, Research Center, Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, PO Box 6800, Buraidah 51452, Kingdom of Saudi Arabia. Tel. +966 (16) 3802267 Ext. 2330. E-mail:
| | - Mohammad S. Alorainy
- From the Department of Pharmacology and Toxicology (Akbar), College of Pharmacy, and Department of Pharmacology and Therapeutics (Alorainy), College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia.
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De Giorgi A, Mallozzi Menegatti A, Fabbian F, Portaluppi F, Manfredini R. Circadian rhythms and medical diseases: does it matter when drugs are taken? Eur J Intern Med 2013; 24:698-706. [PMID: 23611529 DOI: 10.1016/j.ejim.2013.03.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/19/2013] [Accepted: 03/26/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Chronobiology is devoted to the study of biological rhythms. It is possible that a given medication may be therapeutic and safe when administered at some time, but subtherapeutic or poorly tolerated at another. METHODS We focused on some classes of drugs, widely used by the internists, performing a PubMed search with the single drugs associated with the MeSH terms "Chronotherapy", "Circadian rhythm", and "Chronobiology, phenomena". Among the studies found, we considered only those provided with discrete numerosity or clearly stated methodological characteristics. RESULTS The results of available studies were given, along with a series of short take-home messages at the end of each mini-chapter devoted to: antihypertensives, statins, anticoagulants, analgesics, drugs for acid-related disorders, and anti-asthmatic drugs. In particular, evidence of morning vs. evening administration, when applicable, was given for each medication. CONCLUSIONS Adequate evidence seems to support that at least ACE-inhibitors or angiotensin receptor blockers, simvastatin, corticosteroids (slow-release formulation) for arthritic patients, and ranitidine should preferably be administered in the evening. Morning dosing could be better for proton pump inhibitors, whereas time of administration is not crucial for asthma inhalation drugs. Studies are available for other drugs, but not so strong enough to draw definite conclusions. For now, we need prospective intervention trials specifically designed to investigate the long-term effects of a temporal approach to medical therapy. However, since switching to morning-evening administration or vice versa is simple and inexpensive, in some cases it could be considered, remembering that, in any case, adherence remains the crucial point.
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Abstract
Approximately one-third of patients with epilepsy continue to have seizures despite antiepileptic therapy. Many seizures occur in diurnal, sleep/wake, circadian, or even monthly patterns. The relationship between biomarkers and state changes is still being investigated, but early results suggest that some of these patterns may be related to endogenous circadian patterns whereas others may be related to wakefulness and sleep or both. Chronotherapy, the application of treatment at times of greatest seizure susceptibility, is a technique that may optimize seizure control in selected patients. It may be used in the form of differential dosing, as preparations designed to deliver sustained or pulsatile drug delivery or in the form of 'zeitgebers' that shift endogenous rhythms. Early trials in epilepsy suggest that chronopharmacology may provide improved seizure control compared with conventional treatment in some patients. The present article reviews chronopharmacology in the treatment of epilepsy as well as future treatment avenues.
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Affiliation(s)
- Sriram Ramgopal
- Division of Epilepsy and Clinical Neurophysiology, Harvard Medical School, Fegan 9, Boston, MA USA
- Department of Neurology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 USA
| | - Sigride Thome-Souza
- Division of Epilepsy and Clinical Neurophysiology, Harvard Medical School, Fegan 9, Boston, MA USA
- Department of Neurology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 USA
- Psychiatry Department of Clinics Hospital of Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Harvard Medical School, Fegan 9, Boston, MA USA
- Department of Neurology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 USA
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Hermida RC, Ayala DE, Fernández JR, Mojón A, Smolensky MH, Fabbian F, Portaluppi F. Administration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. Chronobiol Int 2012; 30:280-314. [PMID: 23077971 DOI: 10.3109/07420528.2012.709448] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Specific features of the 24-h blood pressure (BP) pattern are linked to progressive injury of target tissues and risk of cardiovascular disease (CVD) events. Several studies have consistently shown an association between blunted asleep BP decline and risk of fatal and nonfatal CVD events. Thus, there is growing focus on ways to properly control BP during nighttime sleep as well as during daytime activity. One strategy, termed chronotherapy, entails the timing of hypertension medications to endogenous circadian rhythm determinants of the 24-h BP pattern. Significant and clinically meaningful treatment-time differences in the beneficial and/or adverse effects of at least six different classes of hypertension medications, and their combinations, are now known. Generally, calcium channel blockers (CCBs) are more effective with bedtime than morning dosing, and for dihydropyridine derivatives bedtime dosing significantly reduces risk of peripheral edema. The renin-angiotensin-aldosterone system is highly circadian rhythmic and activates during nighttime sleep. Accordingly, evening/bedtime ingestion of the angiotensin-converting enzyme inhibitors (ACEIs) benazepril, captopril, enalapril, lisinopril, perindopril, quinapril, ramipril, spirapril, trandolapril, and zofenopril exerts more marked effect on the asleep than awake systolic (SBP) and diastolic (DBP) BP means. Likewise, the bedtime, in comparison with morning, ingestion schedule of the angiotensin-II receptor blockers (ARBs irbesartan, olmesartan, telmisartan, and valsartan exerts greater therapeutic effect on asleep BP, plus significant increase in the sleep-time relative BP decline, with the additional benefit, independent of drug terminal half-life, of converting the 24-h BP profile into a more normal dipping pattern. This is the case also for the bedtime versus upon-awakening regimen of combination ARB-CCB, ACEI-CCB, and ARB-diuretic medications. The chronotherapy of conventional hypertension medications constitutes a new and cost-effective strategy for enhancing the control of daytime and nighttime SBP and DBP levels, normalizing the dipping status of their 24-h patterning, and potentially reducing the risk of CVD events and end-organ injury, for example, of the blood vessels and tissues of the heart, brain, kidney, and retina.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Pontevedra, Spain.
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