And the Answer Is...
Answer: at bedtime
Individuals who have high blood pressure (BP) while asleep are at greater risk of developing diabetes, likely because hypertension has been associated with insulin resistance caused by activation at night of the renin–angiotensin–aldosterone system (RAAS), according to research published in the journal Diabetologia. Blocking nighttime RAAS activity can contribute to efforts to lower BP, help control impaired glucose, and maintain insulin tolerance, according to the study.
A second study published in the same journal showed that hypertensive patients without diabetes who took at least 1 antihypertensive medication at night before bed, instead of in the morning when they awoke, had significantly lower average BP while sleeping and were 57% less likely to develop diabetes after nearly 6 months. The risk of developing diabetes was significantly lower in patients on the nighttime regimen who took angiotensin receptor blockers (ARBs), angiotensin-converting-enzyme (ACE) inhibitors, and beta-blockers, which all decrease RAAS activity. Making the switch to the nighttime regimen did not increase risk of adverse events, according to the researchers, who said directing individuals to take BP medications before bed instead of before breakfast is a no-cost treatment recommendation to which all individuals prescribed the medications can adhere.
