Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Hypertension Medication and Diabetes

Can taking meds at bedtime lower T2D risk?

Publish date:: October 6, 2015

Taking hypertension medication at bedtime was associated with lower diabetes risk, according to a study of 2,012 hypertensive patients without diabetes who were randomized to ingest all of their prescribed hypertension medications upon awakening or the entire daily dose of ≥1 of them at bedtime. The same study group reported in a separate study that sleep-time blood pressure is a highly significant independent prognostic marker for new onset diabetes. Researchers found:

• Compared with the morning group, the nighttime group had a better ambulatory blood pressure control and was at significantly reduced risk of developing diabetes (12% vs 5%).

• Greater benefit was observed for bedtime compared with morning treatment with angiotensin receptor blockers (HR, 0.39), ACE inhibitors (HR, 0.31), and β-blockers (HR, 0.35).

Citation: Hermida RC, Ayala DE, Mojon A, Fernandez JR. Sleep-time BP: prognostic marker of type 2 diabetes and therapeutic target for prevention. Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomized controlled trial. Diabetologia. [Published online ahead of print September 23, 2015].

Commentary: This study lends further support that at least one of a person’s antihypertensive medications should be given at night. The background for this study is that sleeping blood pressure, measured by ambulatory blood pressure monitoring, is a better predictor of CV events than daytime blood pressure. A previous study showed that patients who took at least 1 of their BP meds at bedtime had lower nighttime blood pressures and better 24-hour blood pressure control¹. Another study of patients with chronic kidney disease showed that changing at least 1 antihypertensive to nighttime dosing decreased CV events over 5 years by 72%². This seems like an evidence-based, cheap and easy recommendation to implement that might improve both CV risk and risk of developing diabetes. —Neil Skolnik, MD

1. Hermida RC, Ayala DE, Calvo C, López JE, Mojón A, Fontao MJ, Soler R, Fernández JR. Effects of time of day of treatment on ambulatory blood pressure pattern of patients with resistant hypertension. Hypertension. 2005;46:1053–1059.

2. Hermida RC, Ayala DE, Mojón A, Fontao MJ, Fernández JR. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J Am Soc Nephrol. 2011;22(12):2313-2321.

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