Wednesday, 22 August 2012

Popping the prescribed pill for hypertension at bedtime will help in reducing cardiac attack events during nights to a considerable extent

By Syed Akbar
Hyderabad:  Popping the prescribed pill for hypertension at
bedtime will help in reducing cardiac attack events during nights to a
considerable extent.

“When we sleep our mean blood pressure normally dips in the range of
10 to 20 per cent. This dipping has very important implications on our
health. People, who do not show this nocturnal dip in blood pressure,
are relatively more prone to cardiovascular mortality,” said kidney
specialist Dr Mohammad Abdul Rafay of Apollo Hospitals.

Citing a research study covering more than 1500 people in Ohasama,
Japan, over a period of nine years, Dr Rafay said individuals, who
lacked the dipping pattern (i.e. whose blood pressure does not dip
during sleep), had higher incidence of cardiac events.

He said two different studies published recently by Dr Ramon Hermida
and team from University of Vigo, Spain, might well serve as the real
game changers in the management of hypertension. In the first study,
over 2000 patients with hypertension were randomized to either receive
all anti-hypertensive medications in the morning or receive at least
one anti-hypertensive medication at bedtime.

The researchers followed the patients for five years. The results
showed an improved dipping pattern, sleep time blood pressure control,
24- hour mean BP control and a 60 to 70 per cent reduction in
cardiovascular events in people, who were taking at least one BP
lowering medication at nighttime.

In the second study, patients with chronic kidney disease and
hypertension were divided into two groups. One received all
anti-hypertensive medications in the morning and the other received at
least one BP lowering medication at night. Once again, there was
significant reduction in nighttime BP, overall 24-hour BP control and
cardiovascular events in the group that received bedtime medication.

“While more data is needed to demonstrate that isolated elevation in
nighttime blood pressure can lead to worse outcomes in patients with
hypertension, the research studies have successfully argued that a
small change in the way we prescribe anti-hypertensive medications can
provide a huge protection against cardiovascular events to our
patients,” Dr Rafay said.

The reason nocturnal dip never hit the prime time in blood pressure
management was its lack of reproducibility. A more reliable nighttime
blood pressure measure now appears to be nocturnal hypertension
(average sleep time blood pressure >120/70 mmHg).

He said for hypertension experts, nighttime elevation in blood
pressure has been of concern since the publication of African-American
Study of Kidney Disease and Hypertension (AASK study) results a few
years ago. Interestingly, a sub-study performed with 24-hour
ambulatory blood pressure measurement in a group of AASK patients
demonstrated that 66 per cent of patients had elevated nigh time blood
pressure, although the clinic blood pressures were well controlled.

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