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Revista Portuguesa de Medicina Geral e Familiar

Print version ISSN 2182-5173

Abstract

MENDES, Ângela Oliveira  and  PINHEIRO, Filipa Oliveira. Chronotherapy of antihypertensive drugs: an evidence-based review. Rev Port Med Geral Fam [online]. 2020, vol.36, n.2, pp.153-168. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i2.12620.

Objective: To determine whether nocturnal administration of antihypertensive drugs may have a benefit in terms of efficacy in reducing blood pressure and/or cardiovascular events, morbidity, and mortality compared to morning administration. Data sources: National Guideline Clearinghouse, NHS Evidence, CMA Infobase, The Cochrane Library, DARE and MEDLINE/PubMed. Methods: Search of guidelines, systematic reviews (SR), meta-analysis (MA) and clinical trials published between January 2008 and October 2018, available in English and Portuguese under the terms MeSH ‘Antihypertensive Agents’ and ‘Drug Chronotherapy’. The American Family Physician's Strength of Recommendation Taxonomy (SORT) was used to assess the levels of evidence (NE) and the strength of recommendation (FR). Results: Fifty-five articles were obtained in the initial research, of which 13 fulfilled the inclusion criteria. With nocturnal administration of drugs, greater control of blood pressure values at night was observed, and the reversion of dipper profiles to non-dipper, with no statistically significant differences in the diurnal period. Only MA analyzed global and cardiovascular mortalities, and no statistically significant changes were detected in this parameter between the morning and evening groups; however, a lower relative risk of cardiovascular events in the evening group was evident in three of the studies. Conclusion: The administration of antihypertensive drugs in the nocturnal period proved to have benefit in terms of reduction of blood pressure values and showed superiority in this reduction during nocturnal period, allowing even to revert non-dipper/riser patterns to the dipper. However, further studies, with greater uniformity of criteria and evaluation of CV morbidity and mortality, are required in order to ensure the efficacy and safety of nocturnal administration of antihypertensive drugs.

Keywords : Chronotherapy; Antihypertensive drugs.

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