The Controversy of Chronotherapy in the Management of Systemic Hypertension and its Implications for NAION: A Systematic Review

The notion that nocturnal hypotension may represent the final insult in a multifactorial process that causes nonarteritic ischemic optic neuropathy (NAION) is controversial. Although this notion has not been prospectively proven, the standard of care has remained to recommend avoidance of antihypertensive medications at night in patients who have had NAION. There is a growing body of evidence in the cardiovascular literature that the timing at which medications are taken (i.e. 'chronotherapy') has potentially significant systemic implications; in fact, some researchers have argued that taking anti-hypertensive medications at bedtime improves blood pressure control and decreases the risk of stroke and myocardial infarction. This review highlights this clinically relevant emerging controversy.