Sleep-time blood pressure measurements are a significant prognostic marker for new-onset diabetes, and lowering blood pressure while asleep could reduce the risk for developing diabetes in adults, according to research in Diabetologia.
“Elevated BP during sleep, but not clinical measurements, is a highly significant prognostic marker of the risk of developing diabetes,” Ramón C. Hermida, PhD, director of the bioengineering and chronobiology laboratories at the University of Vigo, Spain, told Endocrine Today. “Lowering asleep BP, a novel therapeutic target that requires ambulatory evaluation, could be a significant method for reducing the risk of diabetes.”
Hermida and colleagues analyzed data from 2,656 Spanish adults without diabetes (1,364 women; mean age, 51 years) who routinely slept at night. Within the cohort, 2,012 adults had hypertension; 644 were normotensive. The hypertensive participants were randomly assigned to ingest all BP-lowering medications upon awakening (n = 1,029) or to take the complete daily dose of at least one BP-lowering medication at bedtime and the remaining medications (if any) upon awakening (n = 983). The study did not specify or require a particular antihypertensive medication. Researchers followed the cohort for a mean of 5.9 years; 190 participants developed type 2 diabetes.
During follow-up, researchers found that mean sleep-time systolic BP was the most significant predictor of new-onset diabetes (for each standard deviation elevation, HR = 1.28; 95% CI, 1.1-1.45). A stepwise Cox regression analysis found that sleep-time systolic BP was the second-most significant prognostic marker for new-onset diabetes after fasting glucose, according to researchers.
Researchers also found that a greater morning or pre-awakening BP surge was significantly associated with lower, not higher, risk for new-onset diabetes.
“Ambulatory BP monitoring is needed not only for proper diagnosis of hypertension and quantification of cardiovascular risk, but also, within this context, for evaluation of the individual’s risk of developing diabetes, rendering ambulatory BP a cost-effective technique that should be recommended in all adults, as recently proposed by the U.S. Preventive Services Task Force,” Hermida said.
In a separate study, Hermida and colleagues analyzed all hypertensive adults in the cohort, who were randomly assigned to take their BP-lowering medication before bedtime or upon awakening. After a mean of 5.9 years, researchers found that adults who took antihypertensive medications at bedtime significantly decreased their ambulatory BP and reduced their risk for developing type 2 diabetes by 57% vs. those who took their medication upon awakening. – by Regina Schaffer
Disclosure: Hermida reports no relevant financial disclosures.