Letter to the Editor
Chronotherapy with anti-hypertensive drugs and glaucoma
Cronoterapia con fármacos antihipertensivos y glaucoma
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Hermida<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> on antihypertensive chronotherapy to improve the control of blood pressure (BP) and reduce vascular risk. As the author notes, several prospective studies have shown that the mean BP in the rest period is a better marker of cardiovascular risk than conventional clinical BP and the 24<span class="elsevierStyleHsp" style=""></span>h measures or the period of activity of ambulatory BP monitoring (ABPM). In the MAPEC study, Dr. Hermida quotes: patients taking antihypertensive medication at bedtime had a lower prevalence of the <span class="elsevierStyleItalic">non-dipper</span> pattern, a higher prevalence of controlled ambulatory BP and a <span class="elsevierStyleItalic">hazard ratio</span> of total cardiovascular events significantly lower than those taking medication in the morning. So, it seems advisable that the full dose of one or more antihypertensive drugs is taken at night.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> At this point, we would like to make some considerations regarding patients with glaucoma. After cataracts, glaucoma is the second leading cause of blindness in the world.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The relationship between hypertension and glaucoma is twofold. On the one hand, observational studies<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> have shown that blood pressure is a risk factor for the development of open-angle glaucoma. Moreover, the degree of BP control is an important factor to take into account in the management of glaucoma. In experimental models of glaucoma, the decrease in ocular perfusion pressure, with ischemic optic nerve damage, is greater when the PA is decreased as supposed to when intraocular pressure is increased.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Several studies<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–9</span></a> have shown that nocturnal arterial hypotension is a risk factor for the development of visual field defects. Also some studies have found that the administration of antihypertensive medication at night,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> in patients with glaucoma, has been associated with greater visual loss when compared to morning administration. The relationship of nocturnal arterial hypotension with the progression of glaucoma is likely to go unnoticed by those who, like us, are not ophthalmologists. Thus, special care should be exercised when indicating the time of administration of antihypertensive medication to patients with this common eye condition and, if nocturnal administration of all or part of the antihypertensive medication is indicated, nocturnal arterial hypotension or an <span class="elsevierStyleItalic">extreme-dipper</span> pattern should be avoided.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Fernández FJ, Merino Rego D, Sesma P. Cronoterapia con fármacos antihipertensivos y glaucoma. Med Clin (Barc). 2016;146:45–46.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cronoterapia con antihipertensivos para mejorar el control de la presión arterial y reducir el riesgo vascular" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.C. 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