New Insights on Chronotherapy in Hypertension: Is Timing Everything?

PURPOSE OF REVIEW: With the wider availability and use of ambulatory blood pressure monitoring, there has been increasing interest in diurnal variations of blood pressure and its clinical significance. Nocturnal hypertension is of particular interest due to its predictive value in cardiovascular and all-cause mortality outcomes. The purpose of this paper is to review the clinical significance of nocturnal hypertension, summarize the literature regarding chronotherapy in hypertension, and explore the potential for nighttime dosing of antihypertensives to improve clinical outcomes.

RECENT FINDINGS: The results from current literature evaluating the effect of nighttime dosing of antihypertensive drugs on blood pressure are inconsistent, with some studies showing a substantial effect of nighttime administration of antihypertensive drugs on blood pressure, and others a more modest effect. Some clinical trials demonstrate a significant improvement in clinical outcomes with nighttime administration of antihypertensive medications and other large trials are currently in progress. Chronotherapy remains an important area of research in hypertension.