geoffrey modest medical blogs

?best to take BP meds at night G      Geoff A. Modest, M.D. Mon 11/18/2019 7:26 AM Geoff A. Modest, M.D.  A  recent Spanish study (the Hygia Chronotherapy Trial) was brought to my attention (thanks to Jon Pincus) confirming the importance of nighttime antihypertensive medication as a means to decrease adverse cardiovascular outcomes (see  htn bedtime dec cvd risk ESC2019  in dropbox, or doi:10.1093/eurheartj/ehz754.) Details: -- 19,084 hypertensive pat ients were randomized to taking their entire dose of antihypertensive medications at bedtime versus upon awakening -- 56% men, mean age 61, BMI 30, nighttime sleep duration 9 hours, diabetes 24%/OSA 4%/smoking 16%/obesity 43%/CKD 30%/prior CVD event 10%/duration of known hypertension 9 years -- baseline office blood pressure 149/86 mmHg, 48-hour mean pressure 132/77 mmHg, non-dippers (those whose blood pressure did...

There is a developing field of circadian physiology/chronobiology/chronotherapeutics finding dramatic differences in gene expression at different times of the day and quite variable differences in drug function depending on when these drugs are taken. A recent blog looked at concerns about aspirin dosing and its effectiveness in cardiac protection (see http://gmodestmedblogs.blogspot.com/2018/07/aspirin-one-dose-does-not-fit-all.html ​  ). In looking at some of this literature, I was struck by a not-so-frequently-looked-at issue, the timing of aspirin taking. -- In brief,     -- transcription factors stimulate genes to make proteins by attaching directly to the DNA     -- there exist “clock proteins”(eg CLOCK, which stands for Circadian Locomotor Output Cycles Kaput (!!), and BMAL1), present in almost all cells in the body, which vary in their quantity depending on the time of day (circadian rhythm ) , and seem to be the major activators ...