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Shafer BM, Kogan SA, McHill AW. Pressure Building Against the Clock: The Impact of Circadian Misalignment on Blood Pressure. Curr Hypertens Rep 2024; 26:31-42. [PMID: 37837518 PMCID: PMC10916535 DOI: 10.1007/s11906-023-01274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW Misalignment between the endogenous biological timing system and behavioral activities (i.e., sleep/wake, eating, activity) contributes to adverse cardiovascular health. In this review, we discuss the effects of recurring circadian misalignment on blood pressure regulation and the implications for hypertension development. Additionally, we highlight emerging therapeutic approaches designed to mitigate the negative cardiovascular consequences elicited by circadian disruption. RECENT FINDINGS Circadian misalignment elicited by work schedules that require individuals to be awake during the biological night (i.e., shift work) alters 24-h blood pressure rhythms. Mechanistically, circadian misalignment appears to alter blood pressure via changes in autonomic nervous system balance, variations to sodium retention, dysregulation of endothelial vasodilatory responsiveness, and activation of proinflammatory mechanisms. Recurring circadian misalignment produced by a mismatch in sleep timing on free days vs. work days (i.e., social jetlag) appears to have no direct effects on prevailing blood pressure levels in healthy adults; though, circadian disruptions resulting from social jetlag may increase the risk of hypertension through enhanced sympathetic activation and/or obesity. Furthermore, social jetlag assessment may be a useful metric in shift work populations where the magnitude of circadian misalignment may be greater than in the general population. Circadian misalignment promotes unfavorable changes to 24-h blood pressure rhythms, most notably in shift working populations. While light therapy, melatonin supplementation, and the timing of drug administration may improve cardiovascular outcomes, interventions designed to target the effects of circadian misalignment on blood pressure regulation are warranted.
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Affiliation(s)
- Brooke M Shafer
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Sophia A Kogan
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Andrew W McHill
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA.
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Abuelazm M, Saleh O, Albarakat MM, Katamesh B, Abdalshafy H, Mahmoud A, Abdelazeem B. The effect of bedtime versus morning dosing of antihypertensive drugs on the cardiovascular outcomes: a systematic review and meta-analysis of randomized controlled trials. J Hypertens 2023; 41:1595-1605. [PMID: 37642592 DOI: 10.1097/hjh.0000000000003508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVE Antihypertensive drugs are one of the most effective strategies to prevent disability and mortality; however, there have been contradictory findings about the best dosing time for antihypertensive drugs. Therefore, we aim to evaluate the effect of bedtime versus morning dosing of antihypertensive drugs on cardiovascular outcomes. METHODS We synthesized randomized controlled studies (RCTs) from the Web of Science, SCOPUS, EMBASE, PubMed, and CENTRAL until 13 October 2022. The risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. The study protocol was registered in PROSPERO with ID: CRD42022368612. RESULTS Five RCTs with 59 200 participants were included. Bedtime dosing was significantly associated with less incidence of myocardial infarction (MI) [RR: 0.80 with 95% CI (0.70-0.91), P = 0.0007] compared with morning dosing; however, there was no statistically significant difference between bedtime and morning dosing, regarding all-cause mortality [RR: 0.77 with 95% CI (0.51-1.16), P = 0.21], cardiovascular mortality [RR: 0.65 with 95% CI (0.35-1.21), P = 0.17], major adverse cardiac events (MACE) [RR: 0.79 with 95% CI (0.56-1.10), P = 0.16], heart failure [RR: 0.68 with 95% CI (0.42-1.09), P = 0.11], cerebrovascular accidents [RR: 0.80 with 95% CI (0.53-1.22), P = 0.30], coronary revascularization [RR: 0.79 with 95% CI (0.50-1.24), P = 0.30}, and angina [RR: 0.91 with 95% CI (0.55-1.50), P = 0.70]. CONCLUSION Evidence about the comparative efficacy of bedtime versus morning dosing of antihypertensives is still uncertain. However, bedtime dosing significantly reduced MI, which warrants more robust RCTs to validate.
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Affiliation(s)
| | - Othman Saleh
- Faculty of Medicine, The Hashemite University, Zarqa
| | - Majd M Albarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Healthcare, Flint
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
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Abstract
Circadian rhythms describe physiological systems that repeat themselves with a cycle of approximately 24 h. Our understanding of the cellular and molecular origins of these oscillations has improved dramatically, allowing us to appreciate the significant role these oscillations play in maintaining physiological homeostasis. Circadian rhythms allow living organisms to predict and efficiently respond to a dynamically changing environment, set by repetitive day/night cycles. Since circadian rhythms underlie almost every aspect of human physiology, it is unsurprising that they also influence the response of a living organism to disease, stress, and therapeutics. Therefore, not only do the mechanisms that maintain health and disrupt homeostasis depend on our internal circadian clock, but also the way drugs are perceived and function depends on these physiological rhythms. We present a holistic view of the therapeutic process, discussing components such as disease state, pharmacokinetics, and pharmacodynamics, as well as adverse reactions that are critically affected by circadian rhythms. We outline challenges and opportunities in moving toward personalized medicine approaches that explore and capitalize on circadian rhythms for the benefit of the patient.
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Affiliation(s)
- Yaakov Nahmias
- Center for Bioengineering, School of Computer Science and Engineering, Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Ioannis P Androulakis
- Department of Biomedical Engineering and Department of Chemical & Biochemical Engineering, Rutgers University, Piscataway, New Jersey 08854, USA; .,Department of Surgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey 08854, USA
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Crea F. Focus on hypertension but also on the 'the digital twin' and on kidney function and disease. Eur Heart J 2020; 41:4531-4534. [PMID: 33639621 DOI: 10.1093/eurheartj/ehaa1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Crespo JJ, Domínguez-Sardiña M, Otero A, Moyá A, Ríos MT, Sineiro E, Castiñeira MC, Callejas PA, Pousa L, Salgado JL, Durán C, Sánchez JJ, Mojón A, Fernández JR, Hermida RC. Bedtime hypertension chronotherapy best reduces cardiovascular disease risk as corroborated by the Hygia Chronotherapy Trial. Rebuttal to European Society of Hypertension officials. Chronobiol Int 2020; 37:771-780. [DOI: 10.1080/07420528.2020.1781351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Juan J. Crespo
- Estructura De Xestión Integrada De Vigo, Servicio Galego De Saúde (SERGAS), Vigo, Spain
| | | | - Alfonso Otero
- Servicio De Nefrología, Complejo Hospitalario Universitario, Estructura De Xestión Integrada De Ourense, Verín E O Barco De Valdeorras, Servicio Galego De Saúde (SERGAS), Ourense, Spain
| | - Ana Moyá
- Estructura De Xerencia Integrada Pontevedra E O Salnés, Servicio Galego De Saúde (SERGAS), Pontevedra, Spain
| | - María T. Ríos
- Estructura De Xestión Integrada De Vigo, Servicio Galego De Saúde (SERGAS), Vigo, Spain
| | - Elvira Sineiro
- Estructura De Xerencia Integrada Pontevedra E O Salnés, Servicio Galego De Saúde (SERGAS), Pontevedra, Spain
| | - María C. Castiñeira
- Estructura De Xestión Integrada De Lugo, Cervo E Monforte De Lemos, Servicio Galego De Saúde (SERGAS), Lugo, Spain
| | - Pedro A. Callejas
- Estructura De Xestión Integrada De Vigo, Servicio Galego De Saúde (SERGAS), Vigo, Spain
| | - Lorenzo Pousa
- Estructura De Xestión Integrada De Vigo, Servicio Galego De Saúde (SERGAS), Vigo, Spain
| | - José L. Salgado
- Estructura De Xestión Integrada De Vigo, Servicio Galego De Saúde (SERGAS), Vigo, Spain
| | - Carmen Durán
- Estructura De Xestión Integrada De Vigo, Servicio Galego De Saúde (SERGAS), Vigo, Spain
| | - Juan J. Sánchez
- Estructura De Xestión Integrada De Santiago De Compostela, Servicio Galego De Saúde (SERGAS), Santiago De Compostela, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
| | - José R. Fernández
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
| | - Ramón C. Hermida
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlanttic), University of Vigo, Vigo, Spain
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Kreutz R, Kjeldsen SE, Burnier M, Narkiewicz K, Oparil S, Mancia G. Blood pressure medication should not be routinely dosed at bedtime. We must disregard the data from the HYGIA project. Blood Press 2020; 29:135-136. [PMID: 32338542 DOI: 10.1080/08037051.2020.1747696] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Reinhold Kreutz
- Department of Clinical Pharmacology and Toxicology, Charité University Medicine, Berlin, Germany
| | - Sverre E Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo Norway
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA
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