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Influence of Time of Day of Blood Pressure-Lowering Treatment on Cardiovascular Risk in Hypertensive Patients With Type 2 Diabetes
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Influence of Time of Day of Blood Pressure-Lowering Treatment on Cardiovascular Risk in Hypertensive Patients With Type 2 Diabetes
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Journal Article
Influence of Time of Day of Blood Pressure-Lowering Treatment on Cardiovascular Risk in Hypertensive Patients With Type 2 Diabetes
2011
Overview
OBJECTIVE: We prospectively investigated in hypertensive patients with type 2 diabetes if bedtime treatment with ≥1 hypertension medications exerts better blood pressure control and cardiovascular risk reduction than conventional therapy, in which all medications are ingested in the morning. RESEARCH DESIGN AND METHODS: We conducted a prospective, randomized, open-label, blinded end point trial on 448 hypertensive patients with type 2 diabetes, 255 men/193 women, mean ± SD age 62.5 ± 10.8 years, randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. Ambulatory blood pressure was measured for 48 h at baseline and again annually or even more frequently (quarterly) after adjustments in treatment. RESULTS: After a median follow-up of 5.4 years, patients ingesting ≥1 hypertension medications at bedtime showed a significantly lower cardiovascular risk (adjusted by age and sex) than subjects ingesting all medications upon awakening (hazard ratio 0.33 [95% CI 0.21-0.54]; P < 0.001). The difference between groups in the adjusted risk of major events (cardiovascular death, myocardial infarction, and stroke) was also statistically significant (0.25 [0.10-0.61]; P = 0.003). Patients treated at bedtime showed significantly lower sleep time blood pressure mean and higher prevalence of controlled ambulatory blood pressure (62.5 vs. 50.9%; P = 0.013). There was a significant 12% cardiovascular risk reduction per each 5 mmHg decrease in asleep systolic blood pressure during follow-up (P < 0.001). CONCLUSIONS: Among patients with diabetes, treatment with ≥1 hypertension medications at bedtime, compared with all medications upon waking, resulted in improved ambulatory blood pressure control and significantly reduced cardiovascular morbidity and mortality.
Publisher
American Diabetes Association
Subject
/ Aged
/ Antihypertensive Agents - administration & dosage
/ Biological and medical sciences
/ blood
/ Blood Pressure - drug effects
/ Blood Pressure Monitoring, Ambulatory
/ Cardiovascular Diseases - etiology
/ Cardiovascular Diseases - mortality
/ death
/ Diabetes Mellitus, Type 2 - complications
/ Diabetes Mellitus, Type 2 - drug therapy
/ Diabetes. Impaired glucose tolerance
/ Endocrine pancreas. Apud cells (diseases)
/ etiology
/ Etiopathogenesis. Screening. Investigations. Target tissue resistance
/ Female
/ Humans
/ Hypertension - complications
/ Male
/ noninsulin-dependent diabetes mellitus
/ patients
/ Public health. Hygiene-occupational medicine
/ Risk
/ sleep
/ stroke
/ Studies
/ women
