We sought to validate, or refute, the common belief that bedtime diuretics are poorly tolerated due to nocturia.
Prespecified prospective cohort analysis embedded within the randomised BedMed trial, in which hypertensive participants are randomised to morning versus bedtime antihypertensive administration.
352 community family practices across 4 Canadian provinces between March 2017 and September 2020.
552 hypertensive patients (65.6 years old, 57.4% female) already established on a single once-daily morning antihypertensive and randomised to switch that antihypertensive to bedtime. Of these, 203 used diuretics (27.1% thiazide alone, 70.0% thiazide/non-diuretic combinations) and 349 used non-diuretics.
Switching the established antihypertensive from morning to bedtime, and comparing the experience of diuretic and non-diuretic users.
Primary outcome: Adherence to bedtime allocation time at 6 months (defined as the willingness to continue with bedtime use, not an assessment of missed doses). Secondary 6-month outcomes: (1) nocturia considered to be a major burden and (2) increase in overnight urinations/week. All outcomes were self-reported and additionally collected at 6 weeks.
At 6 months: Adherence to bedtime allocation time was lower in diuretic users than non-diuretic users (77.3% vs 89.8%; difference 12.6%; 95% CI 5.8% to 19.8%; p<0.0001; NNH 8.0), and more diuretic users considered nocturia a major burden (15.6% vs 1.3%; difference 14.2%; 95% CI 8.9% to 20.6%; p<0.0001; NNH 7.0). Compared with baseline, diuretic users experienced 1.0 more overnight urinations/week (95% CI 0.0 to 1.75; p=0.01). Results did not differ between sexes.
Switching diuretics to bedtime did promote nocturia, but only 15.6% found nocturia a major burden. At 6 months, 77.3% of diuretic users were adherent to bedtime dosing. Bedtime diuretic use is viable for many hypertensive patients, should it ever become clinically indicated.
NCT02990663.
BMJ open. 2023 Jun 06*** epublish ***
Scott R Garrison, Michael Kelmer, Tina Korownyk, Michael R Kolber, Gary Michael Allan, Jeffrey Bakal, Alexander Singer, Alan Katz, Finlay Mcalister, Raj S Padwal, Richard Lewanczuk, Michael D Hill, Kimberlyn McGrail, Braden O'Neill, Michelle Greiver, Donna P Manca, Dee Mangin, Sabrina T Wong, Jessica E M Kirkwood, James P McCormack, Jack M S Yeung, Lee Green
Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada ., Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada., Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada., Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada., Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada., Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada., Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada., Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada., School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada., Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada., Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada., Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.