How should patients take multiple anti-diabetic medications and anti-hypertensive (high blood pressure) drugs throughout the day?

From the Guidelines

Patients taking multiple anti-diabetic and anti-hypertensive medications should follow a consistent daily schedule, taking medications at the most convenient time of day to establish a habitual pattern and improve adherence, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. To manage multiple medications effectively, it's essential to understand the types of medications and their typical dosing schedules.

• Long-acting anti-diabetic medications like metformin (500-2000mg) or SGLT2 inhibitors (such as empagliflozin 10-25mg) are usually taken once daily with breakfast.
• Shorter-acting anti-diabetic medications like sulfonylureas (glipizide 5-20mg) might be taken before meals.
• For blood pressure control, ACE inhibitors (lisinopril 10-40mg) or ARBs (losartan 25-100mg) are typically taken in the morning, while calcium channel blockers (amlodipine 5-10mg) can be taken morning or evening.
• Diuretics like hydrochlorothiazide (12.5-25mg) work best when taken in the morning to avoid nighttime urination. Using pill organizers, setting phone alarms, and taking medications with specific meals can improve adherence, as noted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Consistent timing is crucial because it maintains steady blood levels of medication, providing optimal control of blood sugar and blood pressure throughout the day. Always take medications with food if directed, as some can cause stomach upset, and never adjust dosing without consulting your healthcare provider, as emphasized in the standards of medical care in diabetes-2018 1.

From the Research

Managing Multiple Anti-Diabetic and Anti-Hypertensive Medications

To manage multiple anti-diabetic medications and anti-hypertensive drugs, patients should consider the following:

• Take medications as part of a daily routine to improve adherence 2
• Use pill boxes to organize and keep track of medications 2
• Understand the importance of medication education in improving adherence 2
• Be aware of potential drug-drug interactions, particularly with anti-diabetic agents 3

Anti-Hypertensive Treatment in Diabetic Patients

When choosing anti-hypertensive drugs for diabetic patients, consider the following:

• Angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers are preferred first-line treatments due to their favorable pharmacological profiles 4, 5
• Diuretics, such as thiazides, may impair glucose tolerance and increase low-density lipoprotein cholesterol, but can be used in combination with other agents 4, 6
• The goal of anti-hypertensive treatment is to achieve a blood pressure of less than 130/80 mm Hg 5, 6

Strategies to Improve Medication Adherence

Patients and caregivers can use the following strategies to improve medication adherence:

• Take medications concurrently with a daily routine 2
• Use a pill box to organize medications 2
• Educate patients on the indication, mechanism of action, and therapeutic effects of drugs 2
• Assess individual patient needs and preferences to tailor counseling sessions 2

Considerations for Combining Anti-Diabetic and Anti-Hypertensive Medications

When combining anti-diabetic and anti-hypertensive medications, consider the following:

• Potential drug-drug interactions, particularly with anti-diabetic agents 3
• The metabolic effects of different drug classes, such as the diabetogenic properties of certain antihypertensive drugs 4
• The importance of individualizing treatment and guiding choice of antihypertensive agent based on concomitant clinical disease and target organ system protection 6