Short Communication - Journal of Invasive and Non-Invasive Cardiology (2023) Volume 6, Issue 2
Chronotherapy and endothelin receptor antagonists in hypertension treatmentRay Truant*
Department of Cardiology, University of Glasgow, Scotland, United Kingdom
- *Corresponding Author:
- Ray Truant
Department of Cardiology
University of Glasgow
Scotland, United Kingdom
Received: 24-Feb-2023, Manuscript No. AAINIC-23-90487; Editor assigned: 28-Feb-2023, Pre QC No. AAINIC-23-90487(PQ); Reviewed: 14-Mar-2023, QC No. AAINIC-23-90487; Revised: 20-Mar-2023, Manuscript No. AAINIC-23-90487(R); Published: 27-Mar-2023, DOI:10.35841/aainic-6.2.138
Citation: Truant R. Chronotherapy and endothelin receptor antagonists in hypertension treatment. J Invasive Noninvasive Cardiol. 2023;6(2):138
Throughout the world, hypertension affects around 1.5 billion people and is the most prevalent chronic non-communicable disease. Currently, its impact is expanding, especially in lowincome nations. Low rates of blood pressure (BP) control are a result of the fact that hypertension is still frequently underdiagnosed and undertreated, even in high-income countries. Notwithstanding the vast number of clinical observational studies and randomised trials conducted over the past four decades, it is disappointing to observe that there has been remarkably few ground-breaking research in recent years. The pace of research into new antihypertensive medications and blood pressure mechanisms is drastically slowing. The discussion in the current review focuses on some developments in the treatment of hypertension patients and potentially has practical applications in the years to come. First, it is anticipated that the usage of digital/health technology would increase, albeit certain key issues (the development of non-intrusive and clinically validated devices for ambulatory blood pressure measurement, reliable storing systems permitting rapid analysis) still need to be resolved .
Chronotherapy with medication involves the tailored timing of doses to match the body’s natural daily rhythms and behavioral patterns in order to increase beneficial effects and/or minimize any adverse medication effects across the day and night. The daily patterns of behaviors including the sleep-wake, rest-activity and fasting-feeding cycles, influence the daily fluctuations of gastric pH, gastric emptying, gastrointestinal transit time, organ blood flow, liver enzyme activity, and renal function. The extent to which the internal circadian system also orchestrates these physiological variations is not well understood, although likely to be an important factor that interacts with these daily patterns of behaviors. The sum of these daily circadian (24-h) and behavioral physiological patterns can therefore affect a medication’s bioavailability and duration of action through absorption, distribution, metabolism and elimination . A medication’s effects are also dependent on receptor site availability and function, which can also be affected by the circadian system and by prior behaviors, such as exercise. Currently, very few medications are administered based on the time of day in order to optimize beneficial effects or reduce side-effects. The enormous predictive impact of evening blood pressure has been proven beyond any reasonable question by numerous research carried out at independent facilities. On the basis of this, it has been proposed that controlling blood pressure, preventing or reversing organ damage, and lowering cardiovascular risk may be achieved more effectively by taking antihypertensive medications at night before going to bed than in the morning. In fact, recent research from a Spanish team indicated that evening administration might lower the frequency of serious cardiovascular events linked to hypertension. These facts, however, have come under heavy fire for alleged implausibility. Some studies have been unable to show a difference in blood pressure control between antihypertensive medication treatment in the morning and the evening .
For the time being, it makes sense to suggest combining morning and evening dosing of antihypertensive medications in a subset of patients with severe or resistant hypertension as well as those whose overnight blood pressure is especially high. Antihypertensive medications with a lengthy half-life, able to last the full 24 hours, should be preferred. For instance, when choosing between various diuretics, patients without acute renal failure seem to choose chlorthalidone over the others. In a recent study, patients with uncontrolled hypertension and renal failure (glomerular filtration rate between 15 and 29 mL/ min/1.73 m2 of body surface area) were randomly assigned to receive chlorthalidone or a placebo, with the randomization being stratified by the patients' history of using loop diuretics. Average 24-hour systolic blood pressure was 10.5 mmHg lower in the chlorthalidone group than in the placebo group after 12 weeks of treatment .
Endothelin receptor antagonists
Endothelin controls blood pressure and vascular tone, acting as a potent vasoconstrictor and aiding in the aetiology of hypertension. It results in increased aldosterone synthesis and secretion, fibrosis, endothelial dysfunction, neurohormonal and sympathetic activation, hypertensive end-organ damage, and endothelial dysfunction. Endothelin-1 (ET-1), a peptide generated from endothelial cells with a variety of physiological and developmental roles, including embryogenesis and nociception, is also the biologically dominant member of the endothelin peptide family. More specifically, the endothelin system influences how a particular population of neural crest cells and its offspring develop.
It's interesting to note that ageing changes the equilibrium of chemicals obtained from the endothelium's release and/or activity, including endothelin-1's increased expression, release, and activity. The discovery that patients and experimental models of ageing produce too much endothelin-1 supports the therapeutic advantages of targeting the endothelin system in old hypertension patients. Finally, while endothelin levels are elevated in pre-eclampsia, it is yet unknown if endothelin receptor antagonists can be used to treat this illness .
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