A prospective, randomised trial in Spain showed that in hypertensive patients without diabetes, dosing of blood pressure (BP)-lowering medications at bedtime, compared with dosing upon awakening, resulted in improved BP control and reduced risk of new-onset diabetes. The study included 2,012 hypertensive patients without diabetes, 976 men and 1,036 women, 52.7 ± 13.6 years of age. During a 5.9-year median follow-up, 171 participants developed type 2 diabetes. The bedtime treatment, compared with the morning-treatment group, showed: (1) significantly lower asleep BP mean, greater sleep-time relative BP decline and attenuated prevalence of non-dipping at the final evaluation (32% vs 52%); and (2) significantly less new-onset diabetes after adjustment for fasting glucose, waist circumference, asleep systolic BP mean, dipping classification and chronic kidney disease (4.8% vs 12.1%). Greater benefit was observed with angiotensin receptor blockers, ACE inhibitors and β-blockers. In a separately published analysis of the trial, mean sleeping systolic BP as measured by ambulatory monitoring was a significant and independent predictor of new-onset diabetes. Dosing at bedtime has been shown to reduce cardiovascular morbidity and mortality. Source: http://link.springer.com/西班牙的一项前瞻性，随机试验表明，无糖尿病的高血压患者睡前服降压药，与醒来时给药相比，改善血压控制且新发糖尿病的风险降低。该研究共纳入2012例无糖尿病的高血压患者，976例男性和1036例女性，年龄52.7±13.6岁。在5.9年的中位随访期间，171例发生2型糖尿病。与醒来时给药相比，睡前用药：（1）平均睡着时血压显著更低，睡眠期间相对血压下降更多且最终评估（睡眠）时无血压降低者减少（32％比52％）;（2）经校正空腹血糖，腰围，睡着时平均收缩压，（睡眠期间）血压降低分类和慢性肾脏病等之后，新发糖尿病的风险显著降低（4.8％比12.1％）。血管紧张素受体阻滞剂，ACE抑制剂和β受体阻滞剂表现出更大的益处。在一项单独发表的关于该试验的分析中，自动动态监测到的睡眠时平均收缩压是新发糖尿病显著的独立预测因素。已有研究显示睡前给药降低心血管病发病率和死亡率。来源：http://link.springer.com/
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