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Optimizing treatment for hypertension has focused on reducing cardiovascular risk through reduction of mean blood pressure (BP) under the basic assumption that lower is better, as long as diastolic BP is sufficient to maintain coronary perfusion. However, antihypertensive therapy as currently practiced does not eliminate all hazards associated with BP elevation. Blood pressure variability (BPV) correlates closely with target-organ damage independent of mean BP and transient increases in BP are also triggers of vascular events. So far, there is no definitive outcome data relating specific reduction in BPV to decline cardiovascular events or death. Thus, the decision whether BPV should be considered a new therapeutic target is left to the clinical judgment of physicians and individualized for each patient. However, new evidence suggests that taking an antihypertensive medication at bedtime significantly affects BPV and lowers the risk of cardiovascular events and death. This strategy may provide a means of individualizing treatment of hypertension according to the circadian BPV of each patient and may be a new option to optimize BP control and reduce risk.
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