Effect of Morning versus Bedtime Telmisartan on Ambulatory Blood Pressure and Exercise Response in Diabetic Hypertensive Patients: A Randomised Cross-over Trial

BACKGROUND: Chronotherapy optimises the management of hypertension by synchronising medication with circadian rhythms. When taken in accordance with biological patterns, the long-acting angiotensin II receptor blocker telmisartan may provide extra advantages, particularly for patients with diabetes mellitus who have hypertension. OBJECTIVE: The purpose of this study is to compare the effects of telmisartan 40 mg taken in the morning versus at bedtime on the mean blood pressure (BP) during the day and at night, as well as the BP response to exercise, in patients with diabetes mellitus. METHODS: Forty diabetic hypertensive patients were given telmisartan either in the morning or at bedtime for 8 weeks, followed by a 1-week washout and cross-over in a cross-over randomised controlled trial. In addition to treadmill exercise testing (Bruce protocol), ambulatory BP was measured. RESULTS: Bedtime dosing considerably reduced the systolic and diastolic BP at night when compared to morning dosing. Morning dosing was especially successful in lowering BP increases brought on by exercise. No noteworthy adverse events were observed. CONCLUSION: Bedtime telmisartan dosage improves nocturnal BP control, but morning dosage more successfully lowers exercise-induced BP spikes. Individualised chronotherapy may improve outcomes and control hypertension in diabetic patients.