晚间服用ACE抑制剂更合适

ACE Inhibitor Heart Drugs Best Taken At Bedtime, Study
Many doctors recommend their patients take heart drugs in the morning with their breakfast, but a new study from Canada suggests that one group of drugs, angiotensin-converting enzyme (ACE) inhibitors, works best when taken at bedtime because they reduce the effect of a hormone that is most active during sleep.
Lead author Tami A. Martino, a professor in the Department of Biomedical Sciences at the Unversity of Guelph in Ontario, told the press that:
"Heart drugs are often given to patients in the morning for convenience without considering biological rhythms or time-related risks of adverse effects."
"But if they're given at bedtime, it's better," she added.
Martino and colleagues wrote about their findings in a paper to be published in the Journal of the American College of Cardiology on 17 May.
For some diseases, the time of day or month of medication or surgery can make a difference to success. Asthma and arthritis pain, for example, respond differently when treatment is given at different times.
Martino and colleagues explained in their background information that evidence suggests the heart repairs or remodels itself primarily during sleep. And it's well known that heart attacks and sudden cardiac deaths peak in the early morning, and that people who work nights have disturbed circadian rhythms and higher risk of heart disease.
But while studies have been done to show that timing of heart medication can alter diurnal patterns of blood pressure in patients with high blood pressure, little is known about how the timing of such medication affects heart remodeling.
The researchers decided to test ACE inhibitors because these drugs inhibit the activity of a natural hormone involved in heart repair. The levels of this hormone are highest at night, causing the heart to enlarge and increasing the risk of cardiac damage in heart patients.
For the study, Martino and colleagues used mice bred to have high blood pressure, and examined the effect of the short-acting ACE inhibitor, captopril, on the structure and function of the mice's heart tissue, after the animals underwent surgery that put the heart under greater pressure, thus simulating the conditions that lead to heart failure.
The mice were then split into two groups: one was injected with ACE inhibitor and the other with placebo. Each group was further subdivided into two sets of mice: one set had the injection during wake time, and the other at sleep time. All groups were treated for 8 weeks, starting 1 week after surgery.

The results showed that the mice that received ACE inhibitor at sleep time had improved heart function and their hearts were less enlarged compared to the mice that had received the drug at wake time and the mice given the placebo.
These beneficial effects of the ACE inhibitor also correlated with diurnal changes in genetic expression of ACE in the heart.
However, the ACE inhibitor led to similar drops in blood pressure at both sleep and wake time, suggesting that the time of day differences were not due to blood pressure changes, wrote the authors.
They concluded that:
"The ACE inhibitor captopril benefited cardiovascular remodeling only when administered during sleep; wake-time captopril ACE inhibition was identical to that of placebo."
They said the findings add weight to the idea that the heart and its blood vessels remodel during sleep time, and also shows the importance of diurnal timing for some cardiovascular drugs.
Martino said that giving the ACE inhibitor at sleep time fits in with the biological rhythm of the hormones.
"By targeting those hormones when they're highest during sleep, you're dropping their levels so they're not doing so much damage," she added.
Martino said doctors switching to bedtime use of ACE inhibitors should also consider a short-acting version, because it's not necessary to have it last longer than the night, and this may help reduce the side effects.
She said other researchers are also looking at the possibility that other diseases may also be sensitive to biological rhythms for drug treatment, and gave the examples of insulin release in diabetes and chemotherapy in cancer patients.
"We are now starting to learn that biological and physiological rhythms play an important role in health and disease," said Martino.
"The Primary Benefits of Angiotensin-Converting Enzyme Inhibition on Cardiac Remodeling Occur During Sleep Time in Murine Pressure Overload Hypertrophy."
Martino, Tami A., Tata, Nazneen, Simpson, Jeremy A., Vanderlaan, Rachel, Dawood, Fayez, Kabir, M. Golam, Khaper, Neelam, Cifelli, Carlo, Podobed, Peter, Liu, Peter P., Husain, Mansoor, Heximer, Scott, Backx, Peter H., Sole, Michael J.
J Am Coll Cardiol, 17 May 2011; Vol 57, No 20.
DOI:10.1016/j.jacc.2010.11.022

竟然还能读懂，这对提高英语阅读能力还是蛮有帮助的！谢谢分享

拷回去慢慢看！好东西

这是哪里的文献报道？也不注明出处，我们怎么用这个来说服同行，更不用说要说服医生了。

文章出处：
J Am Coll Cardiol, 17 May 2011; Vol 57, No 20.
DOI:10.1016/j.jacc.2010.11.022

水平不够，但我努力看

睡前服用卡托普利等ACE抑制剂的好处
很多医生会推荐患者在早上，与早餐一起服用药物，但是加拿大的一项新研究显示：血管紧张素酶抑制剂类（ACEI）药物在睡前服用效果最好，能减少睡觉期间最活跃的一种酶的影响。
第一作者作者安大略省Guelph大学生物医学科学学院Tami A. Martino教授告诉本报说“：为了方便，患者通常早上服用心脏病药物，但这样做忽略了人体生物节律或与时间相关的不良反应。”
“但是，如果睡前服用这些药物，效果更好”她补充道。
Martino与同事将他们的发现发表于《Journal of the American College of Cardiology》5月刊。
对于很多疾病，服药或外科手术的的时间对治疗能否成功都有不同的影响。例如，哮喘与关节炎，在不同的时间治疗，治疗效果也不同。

在Martino与同事的文章的背景信息中，他们解释道，心脏自我修改或改造主要发生在睡觉期间，众所周知，早上是心脏病发作和心脏性猝死的高峰期，而夜间工作的患者扰乱的机体的昼夜节律，增加了心脏疾病的发生风险。
已经完成的一些研究显示，定时服用心脏病药物能改变高血压患者白天的血压模式，但对定时用药怎样影响心脏修复的研究却很少。
因ACE抑制剂类药物能参与抑制心脏修复的天然激素的活性，研究人员决定以ACE抑制剂为例，检测ACE抑制剂对心脏修复的影响。受到影响的天然激素在夜间的浓度水平最高，会引起心脏病患者心脏肥大，增加心肌损伤的风险。
为了研究，Martino与同事繁殖出了高血压小鼠模型，检测了短效ACE抑制剂卡托普利对小鼠心脏组织的结构和功能的影响。随后，给小鼠实施外科手术，模拟引发心衰的条件。
然后，小鼠被分为2组：一组注射ACE抑制剂，另一组给予安慰剂。每一组再细分为两组，一组在醒来时给药，另一组则是入睡时。所有小鼠都治疗8周，在外科手术后一周开始治疗。

结果显示，与在清醒时给药和给安慰剂的小鼠相比，睡时给药的小鼠心脏机能改善，心脏增大不明显。
ACE抑制剂的有益的效应与心脏表达ACE的日间变化一致。
作者写道，然而，ACE抑制剂导致清醒服药组与入睡服药组小鼠都发生了血压下降，这提示服药的时间差异不会导致血压变化
他们结论：“睡前服用ACE抑制剂卡托普利有利于心脏修复，醒时服用该类药物的疗效同安慰剂。他们说这项发现为入睡期间发生心脏和血管的理念提供的支持，也证明定时服药某些心血管药物的重要性。
Martino说，睡前服用ACE抑制剂与体内激素的生物节律一致。
“这些激素在入睡时，水平最高，通过靶向降低它们的水平，能减少对心脏的损伤“她补充道。
Martino说，医生在推荐已服用ACE抑制剂的患者睡前服用时，应注意长效ACE抑制剂的情况，没有必要使得药效持续到夜晚结束，这可能会减少副作用。
她说，其他的研究人员也正试图寻找其他对的生物节律敏感的疾病与药物治疗，如糖尿病的胰岛素释放和某些癌症患者的化疗。
Martino. 说：“我们已开始知道生物节律在健康与疾病中有重要作用。”
血管紧张素转化酶抑制剂对压力负荷过大、心脏肥大小鼠的心脏修复的主要益处。

还能读懂...

早晨服用降压药是由于早上血压相对较高，晚上本身患者血压较低，睡前服用ACEI会不会引起心血管事件？

好好学习一下。结合临床。