Nursing, chronotherapeutics and ambulatory blood pressure

For many years the role played by nursing staff in monitoring risk factors in general, and more specifically, hypertension has been recognised as fundamental. Ambulatory Blood Pressure Monitoring (ABPM) is an extremely useful tool in the exploration of clinical practice for the diagnosis and management of hypertensive patients, and its use has become more widespread in various care settings. Knowledge of BP values in different periods, and in patterns of rest and activity is of value when determining prognosis, and serves as a guide for treatment: enforcing relevant lifestyle changes, increasing dosage, switching medication, adding new medication, and also the application of chronotherapy in treatment (Zang et al. 2010). In this regard, it is in our interest to substantiate the results obtained by Cheng et al. (2014), which demonstrate that groups using behavioural intervention, and behavioural intervention plus chronotherapy showed improvement in ABPM readings and circadian rhythm. Furthermore, we would like to underscore that, in cases where the patient is taking two or more antihypertensive drugs (Hermida et al. 2010), the usefulness of administering one of these during the evening to reduce morbidity and mortality rates was proven by Hermida et al. (2011) in their MAPEC (Ambulatory Blood Pressure Monitoring for Prediction of Cardiovascular Events) study. Moreover, we wish to emphasise the benefit in reducing BP during rest periods. Specifically, an optimal SBP overnight means an improvement in cardiovascular prognosis (Hermida et al. 2011, Mancia et al. 2013). In addition, as rest periods show less variation from person to person, it is advantageous to use this period, over a 24-hour period. With regard to morning surge, there is still no overall consensus concerning definition and prognostic value (Mancia et al. 2013). Study results prove the effectiveness of educational intervention, which unfortunately is not always entirely exhaustive in everyday practice. Further studies should provide more information regarding targets in terms of morbidity and mortality, which is the ultimate goal in addressing risk factors. The authors have confirmed that all authors meet the ICMJE criteria for authorship credit (www.icmje.org/ethical_1author.html), as follows: (1) substantial contributions to conception and design of, or acquisition of data or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content and (3) final approval of the version to be published.