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Review
. 2023 Sep 1;29(1):25.
doi: 10.1186/s40885-023-00249-2.

Statement on chronotherapy for the treatment of hypertension: consensus document from the Korean society of hypertension

Sungha Park  1 , Sang-Hyun Ihm  2   3 , In-Jeong Cho  4 , Dae-Hee Kim  5 , Jae Hyeong Park  6 , Woo-Baek Chung  7 , Seonghoon Choi  8 , Hae Young Lee  9 , Hyeon Chang Kim  10 , Il Suk Sohn  11 , Eun Mi Lee  12 , Ju Han Kim  13 , Kwang-Il Kim  14 , Eun Joo Cho  15 , Ki-Chul Sung  16 , Jinho Shin  17 , Wook Bum Pyun  18
Affiliations
Review

Statement on chronotherapy for the treatment of hypertension: consensus document from the Korean society of hypertension

Sungha Park et al. Clin Hypertens. .

Abstract

Nocturnal blood pressure (BP) has been shown to have a significant predictive value for cardiovascular disease. In some cases, it has a superior predictive value for future cardiovascular outcomes than daytime BP. As efficacy of BP medications wanes during nighttime and early morning, control of nocturnal hypertension and morning hypertension can be difficult. As such, chronotherapy, the dosing of BP medication in the evening, has been an ongoing topic of interest in the field of hypertension. Some studies have shown that chronotherapy is effective in reducing nocturnal BP, improving non dipping and rising patterns to dipping patterns, and improving cardiovascular prognosis. However, criticism and concerns have been raised regarding the design of these studies, such as the Hygia study, and the implausible clinical benefits in cardiovascular outcomes considering the degree of BP lowering from bedtime dosing. Studies have shown that there is no consistent evidence to suggest that routine administration of antihypertensive medications at bedtime can improve nocturnal BP and early morning BP control. However, in some cases of uncontrolled nocturnal hypertension and morning hypertension, such as in those with diabetes mellitus, chronic kidney disease, and obstructive sleep apnea, bedtime dosing has shown efficacy in reducing evening and early morning BP. The recently published the Treatment in Morning versus Evening (TIME) study failed to demonstrate benefit of bedtime dosing in reducing cardiovascular outcomes in patients with hypertension. With issues of the Hygia study and negative results from the TIME study, it is unclear at this time whether routine bedtime dosing is beneficial for reducing cardiovascular outcomes.

Keywords: Antihypertensive; Blood pressure; Chronotherapy; Hypertension.

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Conflict of interest statement

S.P has received honorarium from Viatris, Organon, Boryoung, Hanmi, Daewoong, Donga, Celltrion, Servier, Daiichi Sankyo, Chong Kun Dang and Daewon. S.P also has received research grant from Daiichi Sankyo. S.H.I has received honorarium from Boryoung, Hanmi, Daewoong, Donga ST, Celltrion, and Daiichi Sankyo. S.H.I also has received research grant from Donga ST. I.J.C has received honoraria of lecture from Hanmi, Boryong, Dae Woong, Norvatis, Yuhan, and Menarini, D.H.K received honoraria of lecture from Hanmi, Boryong, Viatris, Organon, Norvatis, Bayer, Chong Kun Dong, Yuhan, Daewoong and Daiichi Sankyo, J.H.P received honoraria from Hanmi, Boryong, Chong Kun Dong, Yuhan, Dae Woong, Viatris, Jeil, BMS, and Astra-Zeneca, W.B.C received honoraria of lecture from Yuhan and Daiichi Sankyo, S.C received honoraria from Hanmi, Boryong, CKD, Dae Woong, Daiichi Sankyo and Novartis. H.Y.L received honoraria of lecture from Hanmi, Boryong, CKD, Viatris, and Dae Woong, Daiichi Sankyo, Sanofi, Menarini, and Organon, I.S.S received honoraria of lecture from Hanmi, Boryong, Viatris, Dae Woong, Daiichi Sankyo, Sanofi, Yuhan, and Menarini. E.M.L received honoraria of lecture from Hanmi, Boryong, Viatris, Organon, Norvatis, Bayer, Aju, Chong Kun Dong, Yuhan and GC Biopharma. J.H.K received honoraria from Aju, Boryoung, Chong Kun Dang, Celltrion, Donga, Daewoong, Daiichi Sankyo and Yuhan. K.I.K received honoraria from Hanmi, Boryong, Dae Woong, Daiichi Sankyo, Yuhan, and Samjin; Research fund from Hanmi, Shin Poong, Dae Woong, and Addpharma. J.S received honoraria from Hanmi, Boryong, CKD, and Dae Woong, Daiichi Sankyo, Sanofi, Menarini, and Organon; Advisory fees from for Hanmi, Shin Poong and Inbody, W.B.P received honoraria of lecture from Boryong, Viatris, Aju, Yuhan, Diichi-Sankyo, InnoN, and Daewoong. Rest of the authors have nothing else to declare.

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