Antihypertensiva: beter ’s avonds dan ’s ochtends?

In a reasonably large proportion of patients who take antihypertensive drugs (10-30%), hypertension appears to be therapy resistant; even the use of three antihypertensives does not lower the blood pressure sufficiently. The average nocturnal blood pressure is a better predictor of cardiovascular events than blood pressure measured during the day. Antihypertensives have a stronger effect on nocturnal blood pressure when they are taken in the evening rather than in the morning, whereas the daytime blood pressure does not change significantly. The exact mechanism of this has not yet been unravelled, but randomised, non-blinded studies suggest that this so-called chronotherapy can indeed lower cardiovascular risk. The authors regard this as a promising strategy for patients with therapy-resistant hypertension in whom a nocturnal blood pressure dip does not occur.

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