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Aligning antihypertensives and chronotypes may reduce myocardial infarction risk, study suggests

Taking antihypertensive medication at a time aligned with a patient’s body clock could reduce the risk of myocardial infarction, a study has revealed.

Researchers from the University of Dundee, UK, found that a patient’s chronotype – the time a person feels most suited to sleeping or being awake – can impact how they interact with their antihypertensive treatment.

The findings are published in the journal eClinicalMedicine, and the researchers suggest these could represent a ‘paradigm shift’ in the treatment of hypertension.

Arterial hypertension can cause myocardial infarction, strokes and heart failure. Despite significant progress in evidence-based lifestyle interventions such as diet and exercise guidance, as well as drug therapies which can help with blood pressure control and prevent related complications, hypertension remains a significant public health concern.

Using data collected as part of the Treatment in Morning versus Evening (TIME) randomised clinical trial, the researchers asked over 5,000 participants to complete an online questionnaire designed to assess their chronotype and determine whether they were ‘morning larks’ or ‘night owls’. Half of the participants took their medications in the morning, and the remaining half took their medication in the evening.

The results suggest that taking antihypertensive medication at a time aligned with personal chronotype can provide extra protection for the heart.

The researchers found that when the morning larks – participants who had an earlier chronotype – took their medication in the morning, their risk of myocardial infarction was reduced when compared with the ‘misaligned’ morning larks who took their medication in the evening.

Similarly, the night owls who took their medication in the evening, which aligned with their body clock, were less likely to be hospitalised for myocardial infarction than those who took their medication in the morning.

Dr Filippo Pigazzani, clinical senior lecturer and honorary consultant cardiologist from the University of Dundee, said: ‘These results are exciting because they could represent a ‘paradigm shift’ in the treatment of hypertension. Our research has shown for the first time that considering chronotype when deciding dosing time of antihypertensives – personalised chronotherapy – could reduce the risk of heart attack.’

He stressed that the results needed to be confirmed in new randomised clinical trials of personalised chronotherapy before patients change when they take their antihypertensive medications.

Dr Kenneth Dyar, a circadian biologist from Helmholtz Munich, who helped design the study, said that a person’s internal biological clock determines their chronotype and whether they are more of a ‘morning’ or ‘evening’ person.

He explained: ‘This internal time is genetically determined and affects biological functions over 24 hours, including gene expression, blood pressure rhythms, and how we respond to medications. It’s important for physicians to remember that not all patients are the same. Humans show wide inter-individual differences in their chronotype, and these personal differences are known to affect disease risk.’

The researchers said assessing a patient’s chronotype could be incorporated into clinical practice, providing a straightforward and cost-effective way to prevent myocardial infarction in hypertensive patients using their existing antihypertensive therapies.

A version of this article was originally published by our sister publication Nursing in Practice.

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