Bedtime Ingestion of Hypertension Medication Reduces Risk of Developing Diabetes

Study Questions:

Does bedtime therapy with the entire daily dose of one or more hypertension medications reduce the risk for the development of new-onset diabetes, compared to morning therapy with all medications?

Methods:

This was a prospective, open-label, blinded endpoint trial of 2,012 hypertensive patients with diabetes. Patients were randomized either to ingest all blood pressure (BP)-lowering medications upon awakening or the complete daily dose of one or more at bedtime and remaining ones (if any) upon awakening. The study did not specify or require one unique investigational hypertension medication. Investigators blinded to the hypertension treatment scheme of the patients assessed the development of new-onset diabetes.

Results:

During a median follow-up of 5.9 years, 171 participants developed type 2 diabetes. Compared with the morning-treatment group, patients in the bedtime group had significantly lower asleep BP mean, greater sleep time relative BP decline, and attenuated prevalence of nondipping (32% vs. 52%, p < 0.001) and significantly lower hazard ratio of new-onset diabetes in adjusted analyses (adjusted hazard ratio (HR), 0.43; 95% confidence interval (CI), 0.31-0.61; event-rate 4.8% vs. 12.1% with bedtime and morning treatments, respectively; p < 0.001). Greater benefit was observed for bedtime compared with awakening treatment with angiotensin-converting enzyme inhibitors (HR, 0.31; 95% CI, 0.12-0.89; p = 0.015).

Conclusions:

Ingestion of one or more hypertensives at night, compared with ingestion of all such medications upon awakening, resulted in reduced risk of new-onset diabetes.

Perspective:

This is an interesting analysis that suggests bedtime treatment with the entire daily dose of one or more antihypertensive medications reduces the risk of diabetes mellitus, compared to therapy with all such medications ingested upon awakening. In this study, the most significant predictor of reduced risk of new-onset diabetes was progressive decrease in asleep BP. While these results are intriguing and suggestive of the beneficial effects of bedtime hypertension therapy, they require confirmation. As the authors acknowledge, the ongoing multicenter Hygia project should offer additional insight.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Hypertension, Sleep Apnea

Keywords: Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Diabetes Mellitus, Type 2, Hypertension, Metabolic Syndrome X, Primary Prevention, Risk, Sleep


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