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Chapter-151 Which Patients may Benefit More by Giving Antihypertensive Drugs at Night?

BOOK TITLE: CSI: Cardiology Update 2014

Author
1. Saran RK
2. Chaudhary Gaurav Kr
ISBN
9789351526186
DOI
10.5005/jp/books/12415_152
Edition
1/e
Publishing Year
2015
Pages
4
Author Affiliations
1. Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India, KGMC, Lucknow, Uttar Pradesh, India, King George Medical University, Lucknow, Uttar Pradesh, India, King George’s Medical University, Lucknow, Uttar Pradesh, India, KGMU, Lucknow, UP, India, GIPMER (GB Pant Hospital), New Delhi, India
Chapter keywords
Antihypertensive drugs, nocturnal dipping, MAPEC study, orthostatic hypotension, ambulatory BP

Abstract

Normal circadian pattern of blood pressure is explains on the basis of many theories postulated for the pathogenesis of non-dipping including systemic and vascular inflammation and endothelial dysfunction reasons are abnormal renal sodium handling and disturbances in nocturnal autonomic and associated with nocturnal hypertension and non-dipping pattern with patient. Average day-time and night-time BP can be calculated on the basis of the times of getting up and going to bed. The night-to-day BP ratio represents the ratio between average night-time and day-time BP. The absence of nocturnal dipping of systolic and diastolic BP is due to sleep disturbance, high salt intake in salt sensitive subjects, orthostatic hypotension, diabetic neuropathy and CKD. MAPEC study conducted by Hermida tested the hypothesis of benefit of taking at least one antihypertensive at night. Patients with diabetes, treatment with more than one hypertension medications at bedtime compared with all medications upon waking, resulted in improved ambulatory BP control significantly reduced CV morbidity and mortality with good safety.

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