Spironolactone chronotherapy of hypertensive patient with aldosteronism: Case report

Spironolactone was administered at different circadian stages to optimize the timing of treatment of a hypertensive woman diagnosed with aldosteronism. Ambulatory blood pressure monitoring (ABPM) for 7 days/24 hours was carried out at the end of each stage of treatment administered at a given circadian stage in relation to the time of awakening. The response to treatment was assigned to the time of spironolactone administration to check for any circadian stage-dependent effects. Blood pressure was markedly decreased in response to spironolactone treatment, which was found to be circadian stage-dependent. The largest decrease in systolic and diastolic blood pressure and in pulse pressure can be expected to be reached by treating this patient about 14.4 hours after awakening. This time corresponds approximately to when heart rate variability is decreased the least, which is estimated to occur by treating around 11.2 hours after awakening. Ecphasia, an odd timing of the circadian rhythm in blood pressure, a condition associated with increased cardiovascular disease risk, was, however, the major concern in this patient. Treating 6 hours after awakening was associated with the least deviation of the circadian phase of blood pressure, and may thus be the recommended treatment time. Personalized chronotherapy considering the restoring of a healthy circadian pattern of blood pressure and heart rate in addition to blood pressure lowering can help patients achieve optimal responses to treatment, as illustrated in this case report.