The optimal timing of antihypertensive medication administration for morning hypertension in patients with cerebral infarction
The optimal timing of antihypertensive medication administration for morning hypertension in patients with cerebral infarction
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DOI：
10.1038/hr.2012.25
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发表时间：
2012-07-01
影响因子：
5.4
通讯作者：
Matsumoto, Masayasu
中科院分区：
文献类型：
--
作者：
Hosomi, Naohisa;Sueda, Yoshimasa;Matsumoto, Masayasu
晨间高血压是心血管疾病尤其是脑卒中的独立危险因素。然而，服用抗高血压药物治疗早晨高血压的最佳时间仍不清楚。我们前瞻性地招募了患有缺血性中风（或中风）的晨间高血压的老年患者（65岁以上）。在早晨、晚上或睡前随机给予额外治疗（6个组之一），持续10周（每个时间点/药物n=15）。患者在干预前14天和最后14天在家中测量血压和心率，并将数据记录在血压日记中。在10周干预前后评估患者的尿白蛋白/肌酐比值。本研究共入组270例患者（平均年龄：75.6 ± 5.8岁;女性/男性比例：125/145）。在任何研究药物给药方案后，他们的早晨和晚上收缩压显著降低（P < 0.001）。然而，只有在晚上或睡前服用药物时，早晨和晚上收缩压之间的差异才显着减少（重复测量方差分析P < 0.001）。此外，当在晚上（40.0%）或睡前（45.6%）服用药物时，早晨高血压的恢复率也高于早晨（22.2%;卡方检验P=0.003）。当患者坚持服药方案时，在晚上或睡前服用的降压药物是治疗早晨高血压最有效的方法。高血压研究（2012）35，720-724; doi：10.1038/hr.2012.25; 2012年3月1日在线发表
Morning hypertension is an independent risk factor for cardiovascular diseases, particularly stroke. However, the optimal time at which to take antihypertensive medication to treat morning hypertension remains unclear. We prospectively enrolled elderly patients (over 65 years old) with morning hypertension who had suffered an ischemic stroke (or strokes). Additional treatments (one of six arms) were randomly administered for 10 weeks in the morning, in the evening or at bedtime (n=15 for each time point/medication). The patients measured their blood pressure and heart rate at home for 14 days prior to the intervention and for the final 14 days, and recorded the data in a blood pressure diary. The patients' urinary albumin/creatinine ratios were evaluated before and after the 10-week intervention. A total of 270 patients were enrolled in this study (mean age: 75.6 +/- 5.8 years; female/male ratio: 125/145). Their morning and evening systolic blood pressures were significantly decreased after following any of the study medication dosing schedules (P < 0.001). However, the reductions in the differences between the morning and evening systolic blood pressures were significant only when the medication was taken in the evening or at bedtime (P < 0.001 with repeated measures analysis of variance). Furthermore, the recovery rate from morning hypertension was also higher when the medication was taken in the evening (40.0%) or at bedtime (45.6%), rather than in the morning (22.2%; P=0.003 with the chi(2)-test). Antihypertensive medication taken in the evening or at bedtime is the most effective in treating morning hypertension when the patient adheres to the medication regimen. Hypertension Research (2012) 35, 720-724; doi:10.1038/hr.2012.25; published online 1 March 2012