Tolerability of bedtime diuretics: a prospective cohort analysis

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Hypertension management often involves once-daily medications.
• Common belief suggests bedtime diuretics cause poor tolerance due to nocturia.
• Evidence is needed to validate or refute this belief.

Purpose of the Study:

• To evaluate the tolerability of bedtime diuretic administration in hypertensive patients.
• To assess the impact of switching from morning to bedtime diuretic dosing on nocturia and adherence.
• To compare outcomes between diuretic and non-diuretic users.

Main Methods:

• Prespecified prospective cohort analysis within the randomized BedMed trial.
• Involved 552 hypertensive patients switching from morning to bedtime antihypertensive dosing.
• Compared adherence and nocturia burden between 203 diuretic users and 349 non-diuretic users over 6 months.

Main Results:

• Adherence to bedtime dosing was lower in diuretic users (77.3%) versus non-diuretic users (89.8%).
• More diuretic users considered nocturia a major burden (15.6%) compared to non-diuretic users (1.3%).
• Diuretic users reported an average of 1.0 more overnight urinations per week.

Conclusions:

• Switching to bedtime diuretics increases nocturia, but a significant majority (77.3%) remain adherent.
• Only 15.6% of diuretic users found nocturia a major burden, challenging the common belief.
• Bedtime diuretic use appears viable for many hypertensive patients when clinically indicated.