Bedtime dosing of blood pressure drugs reduces diabetes risk

by Bruce Sylvester: Blood pressure drug dosing at bedtime instead of  in the morning not only lowers blood pressure during sleep but significantly reduces the risk of type 2 diabetes onset, researchers reported on September 23, 2015 in Diabetologia.

The research was led by Dr Ramón Hermida and colleagues from the University of Vigo, Spain.

In their prospective, randomized, open-label, blinded endpoint trial, they enrolled 2,012 hypertensive patients without diabetes, 976 men and 1,036 women with a mean age 53 years.

They randomized the subjects to take all prescribed hypertension medications either at bedtime or upon waking. Median follow-up was 6 years.

Subjects who took drugs nocturnally showed a significantly lower mean blood pressure during sleep and a greater sleep-time relative blood pressure decline. In the nocturnally treated group, there was a lower-prevalence of ‘non-dipping,’ in which patients’ night time blood pressure falls by less than 10% when compared to daytime blood pressure. Non-dipping appeared in 32%  of the nocturnal group and 52% of the morning group.

The investigators reported that 171 subjects developed type 2 diabetes.

After adjusting for fasting glucose, waist circumference, mean asleep systolic blood pressure, dipping classification and chronic kidney disease, the investigators reported a 57% decrease in the risk of new-onset type 2 diabetes in the nocturnal dosing group compared to the morning dosing group.

Between the two study groups, they also observed a greater comparative reduction in diabetes risk for subjects taking angiotensin receptor blockers (ARBs) (61%), ACE inhibitors (69%) and beta blockers (65%).

There were no safety issues with bedtime dosing.

“In hypertensive patients without diabetes, ingestion of the entire daily dose of one or more blood pressure-lowering medications at bedtime compared with ingestion of all such medications upon awakening results in significantly improved sleeping blood pressure control and prevention of new-onset diabetes,” the authors concluded.