Hypertension and chronotherapy: shifting the treatment paradigm.

The treatment of diseases has been based on the concept of homeostasis and has not incorporated an understanding of biologic rhythms and their underlying mechanisms. Biologic rhythms are implicated in cardiovascular events. Failure to recognize the circadian decline in blood pressure may result in iatrogenic chronopathological events, including anterior ischemic optic neuropathy and cerebrovascular accidents. Chronotherapeutics is the purposeful alteration of drug level to match rhythms to optimize therapeutic outcomes and minimize size effects. For the treatment of hypertension, this idea has the potential for a therapeutic paradigm shift.