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Hipertensión Arterial y Cronoterapia

Carlos Calvo, Ramón C. Hermida
2006 Gaceta Médica de Bilbao  
La presión arterial se caracteriza por presentar variación a lo largo de las 24 horas del día. La cronoterapia de la hipertensión arterial contempla esta variación circadiana, con la elevación matutina y el descenso durante el descanso nocturno de la presión arterial, junto con las posibles modificaciones en las características farmacocinéticas y farmacodinámicas de los fármacos antihipertensivos, en función del momento circadiano de su administración. Las diferencias dependientes de la hora de
more » ... la administración de los fármacos antihipertensivos, tanto en la cinética (cronocinética) como en la efectividad terapéutica (cronodinámica) son conocidas. Así, el patrón de variación circadiano de la presión arterial alterado en pacientes hipertensos con insuficiencia renal crónica, sólo se normaliza cuando se administra el calcioantagonista Isradipino en la tarde, pero no en la mañana. Por su parte, la curva dosis-respuesta, la eficacia y la duración de la respuesta terapéutica del alfabloqueante Doxazosina GITS dependen del instante circadiano de administración del fármaco. La administración de otro bloqueante de los canales del calcio como Nifedipino GITS, a la hora de acostarse, reduce de forma significativa los efectos secundarios y aumenta la eficacia antihipertensiva en comparación con la administración del fármaco a la hora de levantarse. Además, en pacientes con hipertensión resistente, la Cronoterapia ha demostrado que mejora el control de la presión arterial, al mismo tiempo que revierte el perfil nodipper, altamente prevalente en este grupo de pacientes. La hipertensión nocturna, caracterizada por la pérdida del descenso del 10-20% en la presión arterial durante las horas de descanso nocturno (patrón no-dipper), aumenta el riesgo de eventos cerebro y cardiovasculares. La Cronoterapia antihipertensiva aporta soluciones en el marco de un tratamiento más individualizado, en función del perfil circadiano de presión arterial de cada paciente, y puede suponer un avance en la optimización del control de la hipertensión arterial y en la reducción del riesgo cardiovascular del paciente hipertenso. Palabras clave: Cronobiología • cronoterapia • hipertensión arterial • riesgo cardiovascular • monitorización ambulatoria de la presión arterial • dipper • no-dipper. Abstract Blood pressure displays appreciable predictable-in-time circadian variation. The Chronotherapy of hypertension takes into account the clinically relevant features of the 24h pattern of blood pressure, e.g., the accelerated morning rise and nighttime decline during sleep, plus potential administration circadian time determinants of the pharmacokinetics and dynamics of antihypertensive medications. Significant administrationtime differences in the kinetics (i.e., Chronokinetics) plus the beneficial and adverse effects (termed Chronodynamics) of antihypertensive drugs are well known. Thus, evening, but not morning, dosing with isradipine significantly reduced and normalized nocturnal blood pressure in hypertensive patients with chronic renal failure. Too, the dose-response curve, therapeutic coverage, and efficacy of doxazosin GITS are all markedly dependent on the circadian time of drug administration. The administration of nifedipine GITS at bedtime significantly reduces secondary effects well increasing antihypertensive efficacy as compared to the administration of the drug upon awakening. Moreover, in patients with resistant hypertension, Chronotherapy has been shown to improve blood pressure control and to revert the non-dipper profile highly prevalent among these patients. Nocturnal hypertension, which is characterized by the loss or even reversal of the expected 10-20% sleep-time blood pressure decline, increases the risk of cardiac and cerebrovascular events. Chronotherapy provides a mean of individualizing treatment of hypertension according to the circadian profile of blood pressure of each patient. The chronotherapeutic strategy constitutes a new option to optimize blood pressure control and to reduce risk. Key words: Chronobiology • chronotherapy • hypertension • cardiovascular risk • ambulatory blood pressure monitoring • dipper • non-dipper. Laburpena Arteria-presioa aldatu egiten da egunean zehar. Arteria-hipertentsioaren kronoterapiak kontuan hartzen du aldakuntza zirkadiano hori; alegia, goizeko igoera, eta gaueko atsedenarekin gertatzen den jaitsiera, baita hipertentsioaren kontrako botikak hartzen diren une zirkadianoaren arabera ezaugarri farmakozinetikoetan eta farmakodinamikoetan gerta daitezkeen balizko aldakuntzak ere. Hipertentsioaren kontrako botikak hartzen diren orduaren araberako aldakuntzak ezagunak dira, bai zinetikari (kronozinetika) eragiten diotenak, bai eraginkortasun terapeutikoari eragiten diotenak ere (kronodinamika). Hala, giltzurrinetako gutxiegitasun kronikoa duten gaixoen arteria-presioaren aldakuntza-eredua normalizatzeko, Isradipino kaltzioantagonista arratsaldean eman behar zaie, eta ez goizean. Bestalde, dosia-erantzuna kurba eta Doxazosina GITS alfablokeatzailearen erantzun terapeutikoaren iraupena aldatu egiten dira botika hartzen den une zirkadianoaren arabera. Oheratzerakoan kaltzioaren kanalak blokeatzen dituen beste botikaren bat hartuz gero -adibidez Nifedipino GITS-, nabarmen murrizten dira ondorio sekundarioak eta areagotu egiten da hipertentsioaren kontrako eraginkortasuna, botika ohetik altxatzean hartzearekin alderatuta. Gainera, kronoterapiak erakutsi duenez, hipertentsio sendoa duten gaixoetan arteria-presioaren kontrola hobetu dezake, eta, aldi berean, era horretako gaixoetan nagusi den ez-dipper profila aldatzea dakar. Gaueko hipertentsioak, gaueko atseden orduetako arteria-presioaren % 10-20 jaitsieraren galera ezaugarri duenak (ez-dipper patroia), garuneko eta bihotzeko hodietako gorabeherak izateko arriskua areagotzen du. Hipertentsioaren kontrako kronoterapiak irtenbideak ematen ditu tratamendu indibidualizatuagoetan, gaixo bakoitzaren arteria-presioaren profil zirkadianoaren arabera, eta aurrerapen handiak ekar ditzake arteriahipertentsioaren kontrola optimizatzeari begira eta hipertentsioa duen gaixoaren arrisku kardiobaskularra murrizteari begira. Hitz giltzarriak: Kronobiologia ü kronoterapia ü arteria-hipertentsioa ü arrisku kardiobaskularra ü ospitaleratzerik gabeko arteria-presioaren monitorizatzea ü dipper ü ez-dipper.
doi:10.1016/s0304-4858(06)74515-2 fatcat:a2wjlpqn2nbqhndrqxtbzqds6u

Predictable Blood Pressure Variability in Healthy and Complicated Pregnancies

Ramón C. Hermida, Diana E. Ayala, Manuel Iglesias
2001 Hypertension  
With the aim of describing the predictable pattern of blood pressure (BP) variability during gestation, we analyzed 2430 BP series systematically sampled by ambulatory monitoring for 48 consecutive hours every 4 weeks from the first obstetric visit (usually within the first trimester of pregnancy) until delivery in 235 normotensive women, 128 women who developed gestational hypertension, and 40 women who had a final diagnosis of preeclampsia. The pattern of variation along gestation of the
more » ... ur means of BP and heart rate was established for each group of women by polynomial regression analysis. For normotensive women, results indicate a steady decrease in BP up to 20 weeks of pregnancy, followed by an increase in BP up to the day of delivery, with an average 8% BP increase between the middle of gestation and delivery. In complicated pregnancies, BP is stable until the 22nd week of gestation and then increases linearly for the remainder of the pregnancy. Complicated pregnancies are characterized by a 9% and 13% increase in systolic and diastolic BPs, respectively, during the second half of gestation. Results also indicate that during the first half of pregnancy, systolic but not diastolic BP is slightly elevated in women who developed preeclampsia compared with those who developed gestational hypertension. During the second half of gestation, the linear trend of increasing BP for women who developed preeclampsia has a significantly higher slope than the trend for women with gestational hypertension. For both healthy and complicated pregnancies, heart rate increases until the end of the second trimester and slightly decreases thereafter. This study of women systematically sampled by 48-hour ambulatory BP monitoring throughout gestation confirms the predictable pregnancy-associated variability in BP and provides proper information for the establishment of reference limits for BP to be used in the early diagnosis of hypertensive complications in pregnancy. Those limits should be developed as a function of gestational age, taking into account the trends in BP throughout pregnancy demonstrated here. (Hypertension. 2001;38[part 2]:736-741.)
doi:10.1161/01.hyp.38.3.736 pmid:11566967 fatcat:uaw6yhboknerpflenkanyxdt5y

Influence of Parity and Age on Ambulatory Monitored Blood Pressure During Pregnancy

Diana E. Ayala, Ramón C. Hermida
2001 Hypertension  
Ayala and Ramón C. Hermida Influence of Parity and Age on Ambulatory Monitored Blood Pressure During Pregnancy  ... 
doi:10.1161/01.hyp.38.3.753 pmid:11566970 fatcat:eiohnznm3fhpvjcpgc2vhwjrgi

Optimal timing for antihypertensive dosing: focus on valsartan

Ramón C Hermida, Diana E Ayala, Carlos Calvo
2007 Therapeutics and Clinical Risk Management  
O´Brien and colleagues (1988) reported that nondipper hypertensive subjects Optimal timing for antihypertensive dosing: focus on valsartan Ramón C Hermida 1 Diana E Ayala 1 Carlos Calvo 2 are significantly  ...  Hermida et al , 2002c .  ... 
doi:10.2147/tcrm.2007.3.1.119 pmid:18360620 pmcid:PMC1936293 fatcat:2brts5onandsncdgb4x257zg5u

Blocking endothelial protein C receptor (EPCR) accelerates thrombus development in vivo

Miguel Centelles, Cristina Puy, Jacinto Lopez-Sagaseta, Kenji Fukudome, Ramón Montes, José Hermida
2010 Thrombosis and Haemostasis  
SummaryThe endothelial protein C receptor (EPCR) plays an anticoagulant role by improving protein C activation.  ...  RCR-16 prevented the interaction between protein C/APC and EPCR as demonstrated by surface plasmon resonance and flow cytometry, and inhibited the activation of protein C on the endothelium.  ...  Introduction Endothelial protein C/activated protein C receptor (EPCR) is an endothelial membrane glycoprotein able to bind protein C and activated protein C (APC) with high affinity (1) .  ... 
doi:10.1160/th09-11-0750 pmid:20352165 fatcat:fa443aeisva45op6bui6lom3p4

Time-Qualified Reference Values for Ambulatory Blood Pressure Monitoring in Pregnancy

Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández
2001 Hypertension  
Hermida et al Tolerance Limits for BP in Pregnancy 749 account only the variance between individuals, as it is the case herein for Figures 1 to 3) . 18, 27 Because only the area of pressures above the  ... 
doi:10.1161/01.hyp.38.3.746 pmid:11566969 fatcat:hydkfc2kprcuxgzu3vopv7vtwi

BIOMEDICAL PATTERN DISCRIMINATION OF NEONATAL CARDIOVASCULAR RISK

Ramón C. Hermida, Fernando Aguado
1993 Japanese Journal of Medical Electronics and Biological Engineering  
doi:10.11239/jsmbe1963.31.supplement_50 fatcat:35t3souqpjdhponxzvfn72jja4

Evaluation of the Blood Pressure Load in the Diagnosis of Hypertension in Pregnancy

Ramón C. Hermida, Diana E. Ayala
2001 Hypertension  
each patient, and processing of the data provided by any given pregnant Diagnosis of Gestational Hypertension Based on the BP Load of a BP Profile Sampled for 48-Hours by ABPM in Pregnant Women Hermida  ... 
doi:10.1161/01.hyp.38.3.723 pmid:11566965 fatcat:wg2yc5bohfa2finrvari2f2o7m

Elevated asleep BP as predictor of type 2 diabetes and therapeutic target for prevention

Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández
2015 Diabetologia  
doi:10.1007/s00125-015-3833-z pmid:26643878 fatcat:tsxnqta4vzfpddzv7d4tlwpjj4

Sleep-time BP: prognostic marker of type 2 diabetes and therapeutic target for prevention

Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández
2015 Diabetologia  
Change in BP was entered as a time-dependent covariate in the Cox regression models c Sleep-time relative BP decline, index of BP dipping, is defined as % decline in BP during night-time sleep relative  ...  Values are shown as mean±SD, unless otherwise stated a The metabolic syndrome: National Cholesterol Education Program Adult Treatment Panel III revised definition [36] b Obesity: BMI ≥30 kg/m 2 c  ... 
doi:10.1007/s00125-015-3748-8 pmid:26399403 fatcat:55osfwakrvb2jpyyjadjuv6zqm

Pharmacogenomics and circadian rhythms as mediators of cardiovascular drug-drug interactions

Yong-Jian Geng, Rosalinda Madonna, Ramon C. Hermida, Michael H. Smolensky
2021 Current Research in Pharmacology and Drug Discovery  
Ramon Hermida: Literature, Data curation, Editing. Michael Smolensky: Conceptualization, Literature, Data curation, Writing, Editing.  ...  et al., 2007 (Hermida et al., , 2011 (Hermida et al., , 2017b (Hermida et al., , 2018a (Hermida et al., , 2018b (Hermida et al., , 2020b Smolensky et al., 2015b Smolensky et al., , 2017b Smolensky et  ... 
doi:10.1016/j.crphar.2021.100025 pmid:34909660 pmcid:PMC8663962 doaj:489eb36f4fa84cb9a7e8ecd4fcc04c9c fatcat:phcce4odlfastpfrznbftugbsq

Asleep blood pressure: relevance to the proper definition of isolated-office and masked hypertension

Ramón C Hermida, Diana E Ayala, Michael H Smolensky, Artemio Mojón, José R Fernández, Francesco Portaluppi
2013 Hypertension Research  
C.  ... 
doi:10.1038/hr.2012.225 pmid:23344133 fatcat:umf56pg7uzfivgpeat5blgjqma

Sleep-Time Blood Pressure and the Prognostic Value of Isolated-Office and Masked Hypertension

Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández
2012 American Journal of Hypertension  
c. hermida (rhermida@uvigo.es)  ...  Sustained hT Sustained hT Sustained hT 8 19.1 21.0 2.36 (1.68-3.31); <0.001 Bioengineering and chronobiology Laboratories, University of Vigo, campus Universitario, Vigo, Spain. correspondence: Ramón  ... 
doi:10.1038/ajh.2011.208 pmid:22089106 fatcat:wqynedy53jg3vcltphkhnczx3u

Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial

Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández
2015 Diabetologia  
correspond to the average of six conventional BP measurements obtained for each participant at the clinic before starting 48 h ABPM b Awake SBP/DBP mean was considered controlled if <135/85 mmHg c  ...  syndrome (%) a 50.8 46.7 0.277 Cigarette smoking (%) 15.1 14.6 0.739 Obesity (%) b 38.4 38.9 0.827 Obstructive sleep apnoea (%) 8.7 8.4 0.824 Anaemia (%) 6.4 6.1 0.774 CKD (%) c  ... 
doi:10.1007/s00125-015-3749-7 pmid:26399404 fatcat:46v5ky4frrhfdh345lfk22qoqa

Sleep-Time Ambulatory BP Is an Independent Prognostic Marker of CKD

Ramón C. Hermida, Diana E. Ayala, Artemio Mojón, José R. Fernández
2017 Journal of the American Society of Nephrology  
Furthermore, progressive treatment-induced decrease of asleep BP, a potential therapeutic target requiring ambulatory BP evaluation, might be a significant method for reducing CKD risk. a P,0.001. b P,0.01. c  ...  ) a 0.88 (0.79 to 0.97) c 48-h Mean 1.27 (1.16 to 1.39) a 1.18 (1.08 to 1.29) a 0.88 (0.79 to 0.99) c Sleep-time relative decline 0.77 (0.71 to 0.85) a 0.80 (0.73 to 0.88) a 0.83 (0.73 to 0.94  ...  1.18 (1.08 to 1.30) a 1.14 (1.03 to 1.25) c 0.97 (0.86 to 1.09) Awake mean 1.21 (1.11 to 1.33) a 1.12 (1.03 to 1.24) c 0.90 (0.80 to 1.02) Asleep mean 1.36 (1.25 to 1.48) a 1.26 (1.15 to 1.37  ... 
doi:10.1681/asn.2016111186 pmid:28455314 pmcid:PMC5576935 fatcat:vqjzoreha5cwxoc4huwwjkpg2q
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