The Experts below are selected from a list of 1329 Experts worldwide ranked by ideXlab platform

Michael H. Smolensky - One of the best experts on this subject based on the ideXlab platform.

  • Chronotherapy for reduction of cardiovascular risk
    Medicina Clinica, 2020
    Co-Authors: Ramon G Hermidaayala, Ramon C Hermida, Michael H. Smolensky
    Abstract:

    Numerous prospective studies establish that elevated asleep blood pressure (BP) constitutes a significant cardiovascular disease (CVD) risk factor, irrespective of daytime office BP measurements or awake and 24h BP measurements. Moreover, except for a small number of studies with flawed methodology, multiple clinical trials of high consistency document significantly better BP-lowering efficacy of hypertension medication and their combinations when ingested at bedtime compared to upon awakening as is customary. Additionally, recent trials conclude bedtime hypertension Chronotherapy markedly reduces CVD risk not only in the general population, but also in more vulnerable patients of advanced age, with kidney disease, diabetes, or resistant hypertension. Collectively, these results call for a new definition of true arterial hypertension and its proper diagnosis and management.

  • bedtime blood pressure Chronotherapy significantly improves hypertension management
    Heart Failure Clinics, 2017
    Co-Authors: Ramon C Hermida, Juan J Crespo, Maria T Rios, Diana E Ayala, Jose R Fernandez, Artemio Mojon, Michael H. Smolensky
    Abstract:

    Consistent evidence of numerous studies substantiates the asleep blood pressure (BP) mean derived from ambulatory BP monitoring (ABPM) is both an independent and a stronger predictor of cardiovascular disease (CVD) risk than are daytime clinic BP measurements or the ABPM-determined awake or 24-hour BP means. Hence, cost-effective adequate control of sleep-time BP is of marked clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of 6 different classes and their combinations significantly improves BP control, particularly sleep-time BP, and reduces adverse effects.

  • bedtime Chronotherapy with conventional hypertension medications to target increased asleep blood pressure results in markedly better chronoprevention of cardiovascular and other risks than customary on awakening therapy
    Heart Failure Clinics, 2017
    Co-Authors: Michael H. Smolensky, Ramon C Hermida, Diana E Ayala, Artemio Mojon, Jose R Fernandez
    Abstract:

    The bases for bedtime hypertension Chronotherapy (BHCT) as superior chronoprevention against cardiovascular disease (CVD) are: (1) correlation between blood pressure (BP) and various risks is greater for ambulatory BP monitoring (ABPM) than office BP measurements (OBPM); (2) asleep BP mean is a better predictor of CVD risk than ABPM awake and 24-hour means and OBPM; and (3) targeting of asleep BP by BHCT with one or more conventional medications versus usual on-awakening therapy better reduces major and total CVD events. BHCT offers the most cost-effective chronoprevention against adverse CVD outcomes in regular and vulnerable renal, diabetic, and resistant hypertensive patients.

  • Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks
    Hypertension Research, 2016
    Co-Authors: Ramon C Hermida, Michael H. Smolensky, Diana E Ayala, Jose R Fernandez, Artemio Mojon, Francesco Portaluppi
    Abstract:

    Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks

  • bedtime hypertension Chronotherapy concepts and patient outcomes
    Current Pharmaceutical Design, 2014
    Co-Authors: Michael H. Smolensky, Ramon C Hermida, Diana E Ayala, Francesco Portaluppi
    Abstract:

    Recent findings indicate cardiovascular disease (CVD) risk is best predicted by asleep systolic blood pressure (SBP), and lowering it by scheduling ≥1 conventional long-acting hypertension medications, alone or in combination, at bedtime significantly lessens vascular-associated risks. Some 20 years ago, four controlled-onset extended-release drug-delivery systems incorporating a calcium channel or β-blocker, with the treatment goal specifically being attenuation of morning rather than asleep BP, were conceived as one type of bedtime hypertension Chronotherapy. However, the CONVINCE outcomes trial failed to substantiate the merit of targeting morning and daytime BP to decrease CVD risk. The HOPE trial, entailing bedtime ramipril treatment for high CVD risk patients, showed substantial reduction of vascular-related events, theorized as the beneficial treatment-time-dependent strong asleep BP lowering. The MAPEC trial was the first prospective randomized treatment-time outcomes investigation to test the worthiness of bedtime hypertension Chronotherapy entailing ≥1 conventional long-acting medications (BTCT), in comparison to the conventional morning-time therapeutic scheme for all medications (CMTT), to normalize asleep BP and diminish CVD risk. BTCT compared to CMTT significantly better lowered asleep BP and most importantly major CVD-associated morbidity and mortality, including myocardial infarction and ischemic and hemorrhagic stroke, by ~60%. CVD risk reduction was strongest when the BTCT included an angiotensin receptor blocker. The HOPE and MAPEC trials provide positive evidence of very significant CVD risk reduction by a BTCT strategy that specifically targets normalization of asleep BP, evidence that awaits conformation by the ongoing Hygia and other outcomes trials.

Ramon C Hermida - One of the best experts on this subject based on the ideXlab platform.

Francesco Portaluppi - One of the best experts on this subject based on the ideXlab platform.

  • Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks
    Hypertension Research, 2016
    Co-Authors: Ramon C Hermida, Michael H. Smolensky, Diana E Ayala, Jose R Fernandez, Artemio Mojon, Francesco Portaluppi
    Abstract:

    Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks

  • bedtime hypertension Chronotherapy concepts and patient outcomes
    Current Pharmaceutical Design, 2014
    Co-Authors: Michael H. Smolensky, Ramon C Hermida, Diana E Ayala, Francesco Portaluppi
    Abstract:

    Recent findings indicate cardiovascular disease (CVD) risk is best predicted by asleep systolic blood pressure (SBP), and lowering it by scheduling ≥1 conventional long-acting hypertension medications, alone or in combination, at bedtime significantly lessens vascular-associated risks. Some 20 years ago, four controlled-onset extended-release drug-delivery systems incorporating a calcium channel or β-blocker, with the treatment goal specifically being attenuation of morning rather than asleep BP, were conceived as one type of bedtime hypertension Chronotherapy. However, the CONVINCE outcomes trial failed to substantiate the merit of targeting morning and daytime BP to decrease CVD risk. The HOPE trial, entailing bedtime ramipril treatment for high CVD risk patients, showed substantial reduction of vascular-related events, theorized as the beneficial treatment-time-dependent strong asleep BP lowering. The MAPEC trial was the first prospective randomized treatment-time outcomes investigation to test the worthiness of bedtime hypertension Chronotherapy entailing ≥1 conventional long-acting medications (BTCT), in comparison to the conventional morning-time therapeutic scheme for all medications (CMTT), to normalize asleep BP and diminish CVD risk. BTCT compared to CMTT significantly better lowered asleep BP and most importantly major CVD-associated morbidity and mortality, including myocardial infarction and ischemic and hemorrhagic stroke, by ~60%. CVD risk reduction was strongest when the BTCT included an angiotensin receptor blocker. The HOPE and MAPEC trials provide positive evidence of very significant CVD risk reduction by a BTCT strategy that specifically targets normalization of asleep BP, evidence that awaits conformation by the ongoing Hygia and other outcomes trials.

  • perspectives on the Chronotherapy of hypertension based on the results of the mapec study
    Chronobiology International, 2010
    Co-Authors: Francesco Portaluppi, Michael H. Smolensky
    Abstract:

    Appreciation of Chronotherapy in hypertension continues to lag, despite clear demonstrations by many studies of (i) clinically relevant dosing-time differences of the beneficial and adverse effects of most blood pressure (BP) medications and (ii) significant association between reduced sleep-time BP decline of non-dippers and their heightened risk of cardiovascular disease (CVD). The Syst-Eur and HOPE outcome trials showed evening administration of nitrendipine and ramipril in these respective studies impacts sleep-time BP, converting the 24-h BP pattern to a more dipper one and in the HOPE study decreasing CVD risk. The CONVINCE study intended to compare BP control and CVD protection afforded by conventional β-blocker and diuretic medications versus a special drug-delivery verapamil formulation as a bedtime hypertension Chronotherapy; however, the trial was terminated prematurely, not based on inadequate performance of the Chronotherapy but on a corporate business decision. The just completed MAPEC study is the first trial specifically designed to prospectively test the hypothesis that bedtime administration of ≥1 conventional medications exerts better BP control and CVD risk reduction than the traditional approach of scheduling all medications in the morning. The results of this 5.6-yr median follow-up study establish that bedtime Chronotherapy more effectively improves BP control, better decreases prevalence of non-dipping, and, most importantly, best reduces CVD morbidity and mortality. This chronotherapeutic approach to hypertension is justified by the fact that BP is usually lowest at night as is sodium excretion, but when sodium intake is excessive or its daytime excretion hampered, nocturnal BP is adjusted higher, to a level required for compensation overnight, via the pressure/natriuresis mechanism, resulting in non-dipping 24-h BP patterning. In diurnally active persons, the entire circadian BP pattern may be reset to a lower mean level and to a "more normal" day-night variation, simply by enhancing natriuresis during the night-the time-of-day when it can be most effective. A modification as simple and inexpensive as switching ≥1 hypertension medications from morning to evening may be all that is needed to normalize nighttime BP, exerting an effect exactly like sodium restriction. Current clinical concepts such as "normotensive non-dipper" (with higher CVD risk than a hypertensive dipper), broad recommendation of pharmacotherapy with exclusively high "smoothness index" medications (without attention to individual patient needs defined by the features of the 24-h BP pattern), and reliance upon static daytime diagnostic BP thresholds based solely on single office cuff assessment necessitate urgent reconsideration.

  • administration time dependent effects of blood pressure lowering medications basis for the Chronotherapy of hypertension
    Blood Pressure Monitoring, 2010
    Co-Authors: Michael H. Smolensky, Ramon C Hermida, Diana E Ayala, Ruana Tiseo, Francesco Portaluppi
    Abstract:

    There is growing interest on how to best tailor blood pressure (BP)-lowering medications according to the circadian (24 h) BP pattern of individual patients, that is, Chronotherapy. Significant and clinically meaningful treatment-time differences in the beneficial and/or adverse effects of at least six different classes of hypertension medications are now known. Generally, calcium channel blockers are more effective with bedtime than morning dosing, and in the case of dihydropyridine derivatives bedtime dosing significantly reduces the risk of edema. Scheduling angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors at bedtime, as opposed to awakening, increases the proportion of patients with properly controlled BP, enhances the sleep-time relative BP decline towards a normal dipping pattern and best reduces urinary albumin excretion, a marker of functional renal status. The Chronotherapy of conventional BP-lowering medications entails their correct scheduling with reference to the body's circadian rhythms, not only to achieve control of daytime and night-time systolic and diastolic BP but to normalize the dipping status of the 24 h pattern. Chronotherapy constitutes a cost-effective strategy for enhancing BP control during both nocturnal sleep and daytime activity and for potentially reducing the risk of cardiovascular disease and end-organ injury of the blood vessels and tissue of the heart, brain, kidney, eye and other organs.

  • chronobiology and Chronotherapy of ischemic heart disease
    Advanced Drug Delivery Reviews, 2007
    Co-Authors: Francesco Portaluppi, Bjorn Lemmer
    Abstract:

    Abstract The occurrence of the clinical manifestations of ischemic heart disease (IHD) – myocardial ischemia and angina pectoris, acute myocardial infarction, and sudden cardiac death – is unevenly distributed during the 24 h with greater than expected events during the initial hours of the daily activity span and in the late afternoon or early evening. Such temporal patterns result from circadian rhythms in pathophysiological mechanisms plus cyclic environmental stressors that trigger ischemic events. Both the pharmacokinetics (PK) and pharmacodynamics (PD) of many, though not all, anti-ischemic oral nitrate, calcium channel blocker, and β-adrenoceptor antagonist medications have been shown to be influenced by the circadian time of their administration. The requirement for preventive and therapeutic interventions varies predictably during the 24 h, and thus therapeutic strategies should also be tailored accordingly to optimize outcomes. During the past decade, two first generation calcium channel blocker chronotherapies have been developed, trialed, and marketed in North America for the improved treatment of IHD. Nonetheless, there has been relatively little investigation of the administration-time (circadian rhythm) dependencies of the PK and PD of conventional anti-ischemic medications, and there has been little progress in the development of new generation IHD chronotherapies. Available epidemiologic, pharmacologic, and clinico-therapeutic evidence demonstrates how the chronobiologic approach to IHD can contribute new insight and opportunities to improve drug design and drug delivery to enhance therapeutic outcomes.

Eiji Shimizu - One of the best experts on this subject based on the ideXlab platform.

  • alteration of the circadian rhythm in peak expiratory flow of nocturnal asthma following nighttime transdermal beta2 adrenoceptor agonist tulobuterol Chronotherapy
    Chronobiology International, 2005
    Co-Authors: Naoto Burioka, Hisashi Suyama, Masanori Miyata, Masahiro Endo, Yasushi Fukuoka, Hirofumi Nakazaki, Katsutoshi Igawa, Eiji Shimizu
    Abstract:

    We investigated the efficacy of nighttime transdermal tulobuterol (beta2-adrenoceptor agonist) Chronotherapy for nocturnal asthma by assessing changes both in the frequency of symptoms and features of the circadian rhythm in peak expiratory flow (PEF), a measure of airway caliber. Thirteen patients with nocturnal asthma were evaluated before and during tulobuterol patch Chronotherapy, applied once daily in the evening for 6 consecutive days. Patients were asked to record their PEF every 4h between 03:00 and 23:00 h for one day. Circadian rhythms in PEF were examined by group-mean cosinor analysis. The group average PEF at 03:00 h, the time during the 24 h when PEF is generally the poorest, before the application of the Chronotherapy, when asthma was unstable and nocturnal symptoms frequent, was 276 +/- 45 L/min. Application of the tulobuterol patch at nighttime significantly increased (p < 0.001) the 03:00 h group average PEF to 363 +/- 67 L/min. Significant circadian rhythms in PEF were observed during the span of study when nocturnal symptoms were frequent as well as with the use of the tulobuterol patch. Before the initiation of tulobuterol Chronotherapy, the bathyphase (trough time of the circadian rhythm) in PEF narrowed to around 04:00h, and the group circadian amplitude was 28.8 L/min. In contrast, the group circadian amplitude significantly (p < 0.01) decreased to 10.4 L/min, and the 24 h mean PEF increased significantly with tulobuterol patch Chronotherapy. These changes indicate that tulobuterol Chronotherapy significantly increased both the level and stability of airway function over the 24 h. The circadian rhythm in PEF varied with the severity and frequency of asthmatic symptoms with and without the nighttime application of the tulobuterol patch medication. We conclude that the parameters of the circadian rhythm of PEF proved useful both in determining the need for and effectiveness of tulobuterol Chronotherapy for nocturnal asthma.

  • alteration of the circadian rhythm in peak expiratory flow of nocturnal asthma following nighttime transdermal β2 adrenoceptor agonist tulobuterol Chronotherapy
    Chronobiology International, 2005
    Co-Authors: Naoto Burioka, Hisashi Suyama, Masanori Miyata, Masahiro Endo, Yasushi Fukuoka, Hirofumi Nakazaki, Katsutoshi Igawa, Eiji Shimizu
    Abstract:

    We investigated the efficacy of nighttime transdermal tulobuterol (beta2-adrenoceptor agonist) Chronotherapy for nocturnal asthma by assessing changes both in the frequency of symptoms and features of the circadian rhythm in peak expiratory flow (PEF), a measure of airway caliber. Thirteen patients with nocturnal asthma were evaluated before and during tulobuterol patch Chronotherapy, applied once daily in the evening for 6 consecutive days. Patients were asked to record their PEF every 4h between 03:00 and 23:00 h for one day. Circadian rhythms in PEF were examined by group-mean cosinor analysis. The group average PEF at 03:00 h, the time during the 24 h when PEF is generally the poorest, before the application of the Chronotherapy, when asthma was unstable and nocturnal symptoms frequent, was 276 +/- 45 L/min. Application of the tulobuterol patch at nighttime significantly increased (p < 0.001) the 03:00 h group average PEF to 363 +/- 67 L/min. Significant circadian rhythms in PEF were observed during the span of study when nocturnal symptoms were frequent as well as with the use of the tulobuterol patch. Before the initiation of tulobuterol Chronotherapy, the bathyphase (trough time of the circadian rhythm) in PEF narrowed to around 04:00h, and the group circadian amplitude was 28.8 L/min. In contrast, the group circadian amplitude significantly (p < 0.01) decreased to 10.4 L/min, and the 24 h mean PEF increased significantly with tulobuterol patch Chronotherapy. These changes indicate that tulobuterol Chronotherapy significantly increased both the level and stability of airway function over the 24 h. The circadian rhythm in PEF varied with the severity and frequency of asthmatic symptoms with and without the nighttime application of the tulobuterol patch medication. We conclude that the parameters of the circadian rhythm of PEF proved useful both in determining the need for and effectiveness of tulobuterol Chronotherapy for nocturnal asthma.

  • circadian rhythm in peak expiratory flow alteration with nocturnal asthma and theophylline Chronotherapy
    Chronobiology International, 2000
    Co-Authors: Naoto Burioka, Hisashi Suyama, Takanori Sako, Eiji Shimizu
    Abstract:

    We investigated changes in the circadian rhythm of peak expiratory flow (PEF) in seven persons with nocturnal asthma for a 24h span when (1) they were symptom free and their disease was stable, (2) their asthma deteriorated and nocturnal symptoms were frequent, and (3) they were treated with theophylline Chronotherapy. Subjects recorded their PEF every 4h between 07:00 and 23:00 one day each period. Circadian rhythms in PEF were assessed using the group-mean cosinor method. The circadian rhythm in PEF varied according to asthma severity. Significant circadian rhythms in PEF were detected during the period when asthma was stable and when it was unstable and nocturnal symptoms were frequent. When nocturnal symptoms were present, the bathyphase (trough time) of the PEF rhythm narrowed to around 04:00; during this time of unstable asthma, the amplitude of the PEF pattern increased 3.9-fold compared to the symptom-free period. No significant group circadian rhythm was detected during theophylline Chronotherapy...

Jose R Fernandez - One of the best experts on this subject based on the ideXlab platform.