Current Hypertension Reviews - Volume 21, Issue 1, 2025

A significant proportion of hypertensive patients are both smokers and obese. Several pathophysiological mechanisms are involved in the combined effect of smoking and obesity on hypertension onset and maintenance. These include increased sympathetic nervous system activity, endothelial dysfunction, inflammation, oxidative stress, and insulin resistance. The presence of these major cardiovascular risk factors may lead to difficult-to-control hypertension as well as substantially increase the risk for an adverse cardiovascular outcome. It is, therefore, imperative that healthcare providers embrace a comprehensive, multifaceted approach in the management of obese hypertensive patients with smoking habits. This review delves into the complex interplay of these risk factors, providing a comprehensive overview of the current literature to aid the deployment of effective clinical management strategies toward reducing the risk profile of affected individuals.

Hypertension, a prevalent global health issue, poses significant risks for morbidity and mortality. The interplay between hypertension and comorbidities like diabetes and chronic kidney disease (CKD) underscores the urgency for effective management strategies. Chronotherapy, aligning medication administration with circadian rhythms, emerges as a promising approach to optimize treatment outcomes.

The objective of this study is to assess the safety and efficacy of the use of ACEIs and ARBs in the chronotherapeutic treatment of hypertension. We aim to clarify the influence of circadian blood pressure patterns on the efficacy of medications and investigate the potential of chronotherapy in the management of hypertension by conducting a thorough examination of the existing literature.

A literature search spanning from January 1980 to 2023 was conducted using PubMed, Scopus and Google Scholar databases. Search terms included ACE inhibitors, ARBs, chronotherapy, hypertension, and circadian rhythm of blood pressure. Studies investigating the effects of chronotherapy with ACEIs and ARBs in hypertensive patients were analyzed.

Chronotherapy offers a personalized approach to hypertension management, leveraging the dynamic nature of circadian rhythms. By administering ACEIs or ARBs at night, the risk of morning blood pressure surges, associated with adverse cardiovascular events, can be mitigated. However, the optimal timing and combination of medications remain areas of ongoing research.

Our review highlights the potential of chronotherapy with ACEIs and ARBs as a promising avenue for hypertension treatment. Further research is warranted to elucidate the mechanisms underlying circadian blood pressure regulation and optimize chronotherapeutic strategies. This comprehensive evaluation underscores the need for personalized treatment approaches tailored to individual circadian rhythms for improved hypertension management and reduced cardiovascular risk.

Hypertension is a chronic medical state and a major determining factor for cardiovascular and renal diseases. Both genetic and non-genetic factors contribute to hypertensive conditions among individuals. The Renin-Angiotensin-Aldosterone System (RAAS) is a major genetic target for the anti-hypertension approach.

The majority of classical antihypertensive drugs were mainly focused on the RAAS signaling pathways. Though these antihypertensive drugs control Blood Pressure (BP), they have mild to severe life-threatening effects. Unrevealing effective hypertensive targets for BP management is essential. The effective targets could emerge either from RAAS-dependent or RAAS-independent pathways and/or through the cross-talks among them.

Analyzing the physiopathological mechanisms of hypertension has the benefit of understanding the interactions between these systems which helps in better understanding of drug targets and the importance of emergence of novel therapeutics.

This review is about the signaling pathways involved in hypertension pathogenesis and their cross-talks and it contributes to a better understanding of the etiology of hypertension.