From the Guidelines
To manage hypertension and hyperglycemia at night, consider taking blood pressure medications in the evening, such as long-acting medications like amlodipine or telmisartan, and adjust the timing of insulin or medications for hyperglycemia, as evidenced by studies suggesting benefits of bedtime dosing for blood pressure control 1. For nighttime hypertension, taking blood pressure medications in the evening rather than morning can help reduce cardiovascular events and mortality, as shown in a randomized controlled trial of 448 participants with type 2 diabetes and hypertension 1. Monitoring blood pressure at home with readings both in the morning and evening can help identify nighttime elevations. Some key points to consider for managing nighttime hypertension and hyperglycemia include:
- Taking long-acting blood pressure medications like amlodipine (5-10mg) or telmisartan (40-80mg) at bedtime
- Adjusting the timing of insulin or medications for hyperglycemia, such as taking long-acting insulin like glargine (Lantus) before bedtime, or medications like metformin extended-release (500-2000mg) with dinner
- Eating dinner earlier (at least 3 hours before bedtime) and limiting carbohydrates at dinner to prevent blood sugar spikes
- Avoiding late-night snacks and promoting regular physical activity during the day
- Maintaining consistent sleep schedules and practicing stress management techniques like meditation before bed to benefit both conditions These nighttime elevations occur because of natural circadian rhythm changes in hormone levels, particularly cortisol and growth hormone, which can raise blood glucose and blood pressure during sleep, and sleep apnea commonly contributes to both conditions and should be evaluated if symptoms like snoring or daytime fatigue are present 1.
From the Research
Hypertension and Hyperglycemia at Night
- Hypertension at night, also known as nocturnal hypertension, is a common complication of essential and secondary hypertension 2.
- Abnormal circadian blood pressure patterns associated with elevated sleep blood pressure include nondipping and reverse dipping, both of which are associated with increased target-organ damage and adverse cardiovascular outcomes 2.
- Nocturnal hypertension can be treated with several approaches that include both lifestyle changes, such as sodium restriction and potassium supplementation, and pharmacological treatments, primarily through the use of bedtime dosing of antihypertensive agents 2.
Treatment of Nocturnal Hypertension
- Evening administration of blockers of the renin-angiotensin-aldosterone system is the most consistently effective of these treatment strategies 2.
- Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors are commonly used to treat hypertension, with ARBs having an improved safety profile and fewer episodes of cough and angioedema compared to ACE inhibitors 3, 4, 5.
- The choice between ARBs and ACE inhibitors depends on individual patient characteristics and comorbidities, such as diabetes and kidney disease 3, 5.
Sleep Timing and Hypertension
- Sleep timing, including bedtime, wake-up time, and sleep midpoint, is associated with the prevalence of hypertension, with both late and early sleep timing increasing the risk of hypertension 6.
- Delaying the sleep midpoint is also associated with an increased risk of hypertension, highlighting the importance of maintaining a consistent sleep schedule 6.
Hyperglycemia and Hypertension
- Hyperglycemia, or high blood sugar, is often associated with hypertension, particularly in patients with type 2 diabetes 5.
- The treatment of hypertension in patients with type 2 diabetes requires careful consideration of the potential effects of antihypertensive medications on glucose metabolism and kidney function 5.