Chronotherapeutics: are there meaningful differences among antihypertensive drugs?

In the past decade, many publications have dealt with the possible relationship between biological rhythms and the incidence of cardiovascular events. A high proportion of treated hypertensive patients have cardiovascular complications, and chronotherapy, which permits the use of drugs that are maximally effective at different points in the circadian cycle, may be an interesting and valuable approach to decreasing morbidity and mortality in these patients. This article summarizes current knowledge on the new science of chronopharmacology, as demonstrated in several clinical studies that have used conventional agents administered at various points in the circadian cycle as well as new chronotherapeutic agents, such as controlled onset extended release (COER)-verapamil. In addition, emphasis is given to a rigorous evaluation of antihypertensive agents in terms of efficacy and duration of effect to obtain adequate and sustained lowering of blood pressure over the 24-hour period.