Forums » Open clinical » Diabetes » What’s the best time of the day to give the anti-hypertensive pills to Diabetics?
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What’s the best time of the day to give the anti-hypertensive pills to Diabetics?
posted at 29/8/2012 9:50 AM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hello Fellows: We all know that Arterial Blood Pressure Monitoring (ABPM) is crucial not only for understanding BP behaviour in diabetics but also to monitor BP treatment´s efficacy. Good BP control has a strong beneficial effect on macro and microvascular diabetic complications, as shown since the UKPDS 38. When we all fall asleep, BP levels go down, because the nervous sympathetic system slows down, leaving the renin-angiotensin system to keep it up, according to many theories and authorities that call it the circadian variability of BP levels. Now it shows up a smart clinical study showing up that if we give the main anti-hypertensive medications (excluding the diuretics for obvious reasons) to diabetics at bedtime it is possible to achieve a 50% higher reduction of cardiovascular events. At a first glance this just sounds simple and great! http://ebm.bmj.com/content/17/4/116.full.pdf+html What do you think about the Chronotherapy concept in Diabetics with Hypertension? Will this new study change your current clinical practice? |
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Re: What’s the best time to give the anti-hypertensive pills to Diabetics?
posted at 30/8/2012 9:44 PM BST
on bmj.com
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Posts: 875
First: 17/6/2011 Last: 20/5/2013 |
I'm really interested in this paper - I've always given my heart failure patients ace-i etc at night time , it does seem to make physiological sense and if we are talking about once a day drugs even if this paper can't be replicated I can't see the harm! sadian ps ok maybe I think this because it supports what I was already doing! |
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Re: What’s the best time to give the anti-hypertensive pills to Diabetics?
posted at 30/8/2012 10:34 PM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
An important clinical aspect. I have been following these principles in my routine practice since a long. It would be better to prescribe antihypertensives to the diabetics at night time to offer them a better protection against the cardiovascular events which are more prone to occur at the night time especially at the early morning hours. In recent years several studies have shown that high nighttime blood pressure is associated with increased cardiovascular risk independently of the average 24 hour blood pressure. As a consequence there has been increasing focus on nighttime blood pressure and how to lower it. One way of addressing the problem is to shift the administration of antihypertensive drugs from morning to nighttime. Studies on non-diabetic patients show that by doing this the nighttime blood pressure can be lowered with 3-5 mm Hg without negative effect on the 24 hour blood pressure. 1. According to the current study by Hermida and colleagues, taking antihypertensive medications at bedtime rather than in the morning has been shown to be associated with an increase in bedtime blood pressure (BP) decline toward a dipping pattern and better BP control and reduction in urinary protein excretion. Nocturnal hypertension is more common among patients with chronic kidney disease (CKD) who may thus experience greater effects of time medications for hypertension.
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Forums » Open clinical » Diabetes » What’s the best time of the day to give the anti-hypertensive pills to Diabetics?
