Melvin Lobo

My name is Professor Melvin Lobo and I'm a blood pressure specialist working in the BART's

heart center barts cardiac center in london where i run um a department in which we have a number of cardiologists focused almost exclusively on blood pressure disorders the hygeia chronotherapy trial published in the european heart journal this is not new research in terms of being interested in the concept of timing of antihypertensive medications but it's certainly the most um

relevant and important trial of its kind because of the scale and because of a number of very sort of strong points in the methodology.

And so research in this area of what we call chronotherapy has been of interest historically.

And we've been sitting on this information for quite some time, but stuck in a groove, continuing to recommend patients to take medications predominantly in the morning time.

One example would be we are

well aware that the renin-angiotensin system is predominantly active during sleep.

So drugs such as ACE inhibitors and angiotensin receptor blockers have been very clearly shown to have improved effect when given at nighttime.

And yet this has not been common practice.

Another example would be the calcium channel blocker classes of drugs.

And in particular with amlodipine, there's been quite a lot of work

to demonstrate that if you use amlodipine at nighttime rather than morning time dosing, you see much improved pharmacokinetic profiles with longer half-life of the drug and greater peak plasma concentrations and greater blood pressure luring effect with interestingly less in the way of adverse effects such as ankle swelling.

And so I think the profession has

to some extent overlook this because perhaps historically we've been teaching doctors and medical students that blood pressure is higher during the day than at nighttime.

And that's obviously true.

Blood pressure tends to dip at night in a healthy population.

And therefore one might want the majority effect of a drug to happen during the daytime and be less concerned about nighttime efficacy

And therefore, historically, there's been this tendency to advise patients to take antihypertensive medication in the morning time.

And I think this study is probably going to disrupt that legacy to some extent.