TITLE

Influence of Time of Day of Blood Pressure-Lowering Treatment on Cardiovascular Risk in Hypertensive Patients With Type 2 Diabetes

AUTHOR(S)
HERMIDA, RAMON C.; AYALA, DIANA E.; MOJON, ARTEMIO; FERNANDEZ, JOSE R.
PUB. DATE
June 2011
SOURCE
Diabetes Care;Jun2011, Vol. 34 Issue 6, p1270
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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.
ACCESSION #
65098987

 

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