Statement on chronotherapy for the treatment of hypertension: consensus document from the Korean society of hypertension.

Nocturnal blood pressure (BP) has been shown to have a significant predictive value for cardiovascular disease. In some cases, it has a superior predictive value for future cardiovascular outcomes than daytime BP. As efficacy of BP medications wanes during nighttime and early morning, control of nocturnal hypertension and morning hypertension can be difficult. As such, chronotherapy, the dosing of BP medication in the evening, has been an ongoing topic of interest in the field of hypertension. Some studies have shown that chronotherapy is effective in reducing nocturnal BP, improving non dipping and rising patterns to dipping patterns, and improving cardiovascular prognosis. However, criticism and concerns have been raised regarding the design of these studies, such as the Hygia study, and the implausible clinical benefits in cardiovascular outcomes considering the degree of BP lowering from bedtime dosing. Studies have shown that there is no consistent evidence to suggest that routine administration of antihypertensive medications at bedtime can improve nocturnal BP and early morning BP control. However, in some cases of uncontrolled nocturnal hypertension and morning hypertension, such as in those with diabetes mellitus, chronic kidney disease, and obstructive sleep apnea, bedtime dosing has shown efficacy in reducing evening and early morning BP. The recently published the Treatment in Morning versus Evening (TIME) study failed to demonstrate benefit of bedtime dosing in reducing cardiovascular outcomes in patients with hypertension. With issues of the Hygia study and negative results from the TIME study, it is unclear at this time whether routine bedtime dosing is beneficial for reducing cardiovascular outcomes.

Can acupuncture affect the circadian rhythm of blood pressure? A randomized, double-blind, controlled trial.

OBJECTIVES: The objective of the study was to investigate the effect of acupuncture on the circadian rhythm of blood pressure (BP) in patients with hypertension. DESIGN: The study was designed as a randomized, double-blind, controlled trial. Subjects were randomly divided into an active acupuncture group and a sham acupuncture group. Each patient received real or sham acupuncture treatment twice a week for 8 weeks. Acupuncture needles were inserted at bilateral ST 36 plus PC 6; placebo points. SUBJECTS: Thirty-three (33) patients with essential hypertension were the subjects. OUTCOME MEASURES: Twenty-four (24)-hour ambulatory BP was assessed before and after treatment. RESULTS: After the treatment period, there was a significant increase in nocturnal diastolic BP dipping compared to that at baseline (10.20±7.56 mm Hg versus 5.21±10.19 mm Hg, p=0.038) in the active acupuncture group but not in the sham acupuncture group. The nocturnal diastolic BP dipping response to active acupuncture treatment was significantly different from the response seen with the sham acupuncture treatment (p=0.041). The number of dippers also increased from 4 to 8 in the active acupuncture group. Average systolic and diastolic BP was not changed significantly except for nighttime diastolic BP (90.32±11.47 mm Hg to 87.83±9.16 mm Hg, p=0.041). CONCLUSIONS: It is suggested that acupuncture treatment could be useful for improving the circadian rhythm of BP in patients with hypertension.

The acute effect of acupuncture on endothelial dysfunction in patients with hypertension: a pilot, randomized, double-blind, placebo-controlled crossover trial.

OBJECTIVES: The objective of the study was to test whether acupuncture improves endothelial dysfunction in patients with hypertension and compare the effects of different acupoints to find out which one is the most suitable for the long-term follow-up study. DESIGN: This study is a pilot, randomized, double-blind, placebo-controlled crossover trial. Subjects were randomly assigned to a sequence of four acupuncture treatment phases, each for 15 minutes with a 7-day washout period in between. Acupuncture needles were inserted at bilateral ST 36; PC 6; ST 36 plus PC 6; and placebo points. SUBJECTS: Fifteen (15) patients with essential hypertension were the subjects. OUTCOME MEASURES: Flow-mediated dilation (FMD) and blood pressure were assessed before and after acupuncture treatment. RESULTS: FMD significantly improved with the acupuncture treatment at ST 36 (0.266 +/- 0.078 mm to 0.306 +/- 0.077 mm, p = 0.003) and ST 36 plus PC 6 (0.284 +/- 0.098 mm to 0.332 +/- 0.103 mm, p < 0.001). In contrast, FMD was unchanged after the acupuncture treatment at PC 6 or the placebo treatment. The FMD response to the acupuncture treatment at ST 36 plus PC 6 was significantly different from the response to the acupuncture treatment at PC 6 and the placebo treatment (p < 0.05, p < 0.01, respectively). The acupuncture treatment at ST 36 significantly increased FMD compared to the placebo treatment (p < 0.05). CONCLUSIONS: This study demonstrates that the acute treatment of acupuncture in hypertensive patients improves endothelial dysfunction. The beneficial effect of acupuncture could be of clinical importance to prevent the progression of cardiovascular diseases in hypertensive patients. However, the potential role of acupuncture treatment for long-term therapy has not been examined. Further studies will be necessary to demonstrate whether long-term acupuncture treatment can sustain the improvement in endothelial dysfunction.

Bloodletting-induced cardiomyopathy: reversible cardiac hypertrophy in severe chronic anaemia from long-term bloodletting with cupping.

Cardiac hypertrophy in a patient with severe iron deficiency anaemia associated with long-term bloodletting using cupping, called 'puhang' in oriental medicine, is discussed using chest electrocardiographic and radiographic images. With iron supply, the patient showed remarkable improvement of cardiomegaly, which is a unique feature of chronic severe iron deficiency anaemia.

Inhibition of histone deacetylation blocks cardiac hypertrophy induced by angiotensin II infusion and aortic banding.

BACKGROUND: A number of distinct stress signaling pathways in myocardium cause cardiac hypertrophy and heart failure. Class II histone deacetylases (HDACs) antagonize several stress-induced pathways and hypertrophy. However, cardiac hypertrophy induced by transgenic overexpression of the homeodomain only protein, HOP, can be prevented by the nonspecific HDAC inhibitors trichostatin A and valproic acid, suggesting that alternate targets that oppose class II HDAC function might exist in myocardium. We tested the effects of several HDAC inhibitors, including a class I HDAC-selective inhibitor, SK-7041, on cardiac hypertrophy induced by angiotensin II (Ang II) treatment or aortic banding (AB). METHODS AND RESULTS: Cardiac hypertrophy was induced by chronic infusion of Ang II or by AB in mice or rats and evaluated by determining the ratio of heart weight to body weight or to tibia length, cross-sectional area, or echocardiogram. Cardiac hypertrophy induced by Ang II or AB for 2 weeks was significantly reduced by simultaneous administration of trichostatin A, valproic acid, or SK-7041. Echocardiogram revealed that exaggerated left ventricular systolic dimensions were relieved by HDAC inhibitors. HDAC inhibitors partially reversed preestablished cardiac hypertrophy and improved survival of AB mice. The expressions of atrial natriuretic factor, alpha-tubulin, beta-myosin heavy chain, and interstitial fibrosis were reduced by HDAC inhibition. CONCLUSIONS: These results suggest that the predominant effect of HDAC inhibition, mainly mediated by class I HDACs, is to prevent cardiac hypertrophy in response to a broad range of agonist and stretch stimuli.