In the Journals

Hypertension medication before bedtime reduces diabetes risk

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September 24, 2015

Adults with hypertension who do not have diabetes have a lower risk for developing the disease when taking their blood pressure medication at bedtime compared with adults who take the medication upon awakening, according to research in Diabetologia.

In a randomized, prospective, open-label, blinded endpoint trial, the researchers also found that adults who took antihypertensive medications at bedtime significantly decreased their ambulatory BP.

“Ingesting hypertension medications at bedtime, instead of upon awakening in the morning, improves asleep BP control and markedly reduces the risk of diabetes,” Ramón C. Hermida, PhD, director of the bioengineering and chronobiology laboratories at the University of Vigo, Spain, told Endocrine Today.

Hermida and colleagues analyzed data from 2,012 Spanish adults with hypertension but without diabetes (1,036 women; mean age, 53 years; mean BMI, 29 kg/m²; mean duration of hypertension, 6.8 years) who adhere to a routine of daytime activity and nighttime sleep. Participants were randomly assigned to ingest all BP-lowering medications upon awakening (n = 1,029) or to take the complete daily dose of one or more BP-lowering medications at bedtime and the remaining medications (if any) upon awakening (n = 983). The study did not specify or require any particular antihypertensive medication. Researchers followed the cohort for a mean of 5.9 years.

Participants in the bedtime group had lower mean systolic and diastolic BP vs. the morning treatment group (P < .001). There were more patients in the bedtime group with well-controlled ambulatory BP vs. the morning group, according to researchers. In addition, compared with the morning group, the bedtime group had a lower proportion of patients with a “non-dipper” pattern — nighttime BP falling by less than 10% compared with daytime BP (52% vs. 32%; P < .001).

During follow-up, 171 participants developed type 2 diabetes; 4.8% of cases in the bedtime group and 12.1% in the morning group. After adjustment for fasting glucose, waist circumference, ambulatory BP, “dipping” classification and chronic kidney disease, adults in the bedtime group had a significantly lower HR for new-onset diabetes (HR = 0.43; 95% CI, 0.31-0.61).

“Changing the time of ingestion of hypertension medications, a zero-cost intervention, has been shown to reduce cardiovascular morbidity and mortality and, in keeping with the new findings reported in Diabetologia, also significantly reduces the risk of developing diabetes,” Hermida said. “The results from this randomized clinical trial indicate a significant 57% decrease in the risk of developing diabetes in the bedtime compared to the awakening treatment regimen.”

The ongoing Hygia Project, involving 40 clinical sites in northwest Spain and under the coordination of the University of Vigo, has recruited more than 18,000 patients who currently undergo periodic evaluation by ambulatory BP monitoring to corroborate the study findings, Hermida said. by Regina Schaffer

Disclosure: Hermida reports no relevant financial disclosures.