Night-time Chronotherapy with Diuretics: Effect on Sleep Quality and Duration in Patients with Hypertension in Lusaka, Zambia
Keywords:
Chronotherapy, Hypertension, Quality of Sleep, Sleepiness
Abstract
Poor sleep plays an important role in the prevalence of hypertension. It increases the prevalence rate to 60%. The night-time dosing of blood pressure-lowering drugs has yielded positive results. Scholars have rarely investigated the relationship between night-time dosing of diuretics and the quality of sleep. The study aimed at evaluating quality and duration of sleep while on night-time dosing of diuretics and determine the commonly used blood pressure-lowering medication at University Teaching Hospital. The study was a Prospective Cohort Study with 12 weeks follow-up. The sample consisted of 46 patients with hypertension, and on a diuretic, 25 of whom were taking their medication in the evening at 10 PM (study group), and 18 were in the 10 AM dosing schedule as a control. Overall, 43 were included in the analysis. Baseline and follow-up at 2, 8 and 12 Sleep quality and duration, and blood pressure level were available for 43 (93.5%) individuals. The study recruited more women (76.1%), and the majority were on hydrochlorothiazide and amiloride combination (65.2%). The 10 PM dosing showed better in quality of sleep and duration, and blood pressure-lowering as the follow-up continued with a p-value of less than 0.05 for Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and for the blood pressure-lowering at 12 weeks. The study showed beneficial effects of 10 PM dosing of diuretics in hypertensive patients, and the diuretic effect does not affect the quality and duration of sleep. Further, 10 PM dosing lowers the blood pressure significantly compared with 10 AM.References
1. World Health Organisation (2013). World Health Day Report: A global brief on hypertension; silent killer, a global public health crisis.
2. JNC VII guidelines, 2013.
3. Pittsburgh Sleep Quality Index -Sleep Quality Assessment Tool.
4. The Epworth Sleepiness Scale
5. Gottlieb DJ, Redline S, Nieto FJ. Association of usual sleep duration with hypertension: the Sleep Heart Health Study Sleep. 2006; 29 (8): 1009 - 1014.
6. Albert WD. Epidemiology of Hypertension. Drug and Diseases update. 2013 www.medscape.com (February, 2014)
7. Hermida RC, Smolensky M. Chronotherapy of hypertension. Current Opinion Nephrology Hypertension 2004; 13: 501–550.
8. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC Study. Chronobiology. International. 2010: 27: 1629–1651.
9. Kario K, Schwartz JE, Pickering TG. Changes in nocturnal blood pressure dipping status in hypertensives by night-time dosing of alpha-adrenergic blocker, doxazosin; results from the HALT study. Hypertension 2000; 35: 787–794.
10. Neutel JM, Smith DH. The circadian pattern of blood pressure: cardiovascular risk and therapeutic opportunities. Current Opinion Nephrology Hypertension.1997; 6(3):250-6.
11. Basil NO, Esther NO, Jayne NAA. Diuretic Drugs Benefit Patients with Hypertension More with Night-time Dosing. Therapeutic Advances in Drug Safe; 2012; 3(6):273-278.
12. Ministry of Health, Zambia National Formulary Committee. Standard Treatment Guidelines, Essential Medicines List, Essential Laboratory Supplies for Zambia. 3rd edition, 2013. Lusaka, Zambia.
13. Ferdinand K, Ferdinand D. Race-based therapy for hypertension. Possible benefits and potential netfalls. Expert Review Cardiovascular Therapy. 2008; 6: 1357–1366.
14. Gombert T, Steichen O, Plonin P. Hypertensive disease in subjects born in Sub-Sahara Africa or in Europe referred to a hypertension unit. A cross-sectional study. Bull Academy of Natural Medicine. 2007; 191: 1745–1754, discussion 1754–1755.
16. McLennan WJ. Diuretics in elderly: how safe? British Medical Journal 1988; 19(296) no 6636 page 1551.
17. Khurship F, Aqil M, Alam MS, Kapur P,Pillai KK. Monitoring of adverse drug reactions associated with antihypertensive medicines at the University Teaching Hospital in New Delhi. DARU Journal of Pharmaceutical Sciences. 2012; 20:34
18. Sica D. Thiazide and loop diuretics. Clinical Cornerstone 2008; 4: 439–442.
19. National Center for Health Statistics. Quick Statistics: Percentage of adults who reported an average of 6 hours of sleep per 24-hour period, by sex and age group - United States. 2005; 54( 37): 933.
20. Hoevenaar-Blom MP, Spijkerman AMW, Kromhout D, Van den Berg JF, Verschuren WMM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN Study. SLEEP; 2011; 34(11):1487-1492.
21. Goma FM, Nzala SH, Olusegun B, Songolo P, Zyaambo C, Rudatsikira E, et al. prevalence of hypertension and its correlates in Lusaka urban district of Zambia: a population-based survey. International Archives of Medicine. 2011; 4:34 doi:10.1186/1755-7682-4-34.
22. Chikao I, Yoshihiko S, Toshiaki O, Kyoichi M, The fixed-dose combination of Losartan/HCTZ elicits potent BP lowering during night time in obese hypertensive patients. Journal of Clinical Medical Research. 2014; 6(1): 8–16.
23. Williams B, Lacouriccere Y, Schumacher H, Gosse P, Neutel JM. Antihypertensive efficacy of Telmisartan Vs Ramipril over the 24h dosing period, including the critical early morning hours: a pooled analysis of the PRISMA I and II randomised trial. Journal of Human Hypertension. 2009; 23, 610–619
24. Zeng J, Jia M, Ran H, Tang H, Zhang Y, Zhang J, et al. Fixed-combination of amlodipine and diuretic chronotherapy in the treatment of essential hypertension: improved blood pressure control with bedtime dosing-a multicenter, open-label randomised study. Hypertension Research. 2011; 34(6):767-72.
25. Portaluppi F, Michael HZ, Smolensky MH. Perspectives on the chronotherapy of hypertension based on results of MAPEC study. Chronobiology International. 2010; 27(8): 1652–1667.
26. Thomas M, Sakir U, Peter B. Management of Hypertension with fixed-dose combination of Candesartan and HCTZ: Patient perspectives and clinical utility. Vascular Health and Risk Management. 2009; 5 1043–1058
27. Wrzus C, Brandmaier AM, Von Oertzen T, Mu ̈ller V, Wagner GG. A New Approach for Assessing Sleep Duration and Postures from Ambulatory Accelerometry. PLoS ONE. 2012; 7(10): e48089. doi:10.1371/journal.pone.0048089, (April, 2014).
2. JNC VII guidelines, 2013.
3. Pittsburgh Sleep Quality Index -Sleep Quality Assessment Tool.
4. The Epworth Sleepiness Scale
5. Gottlieb DJ, Redline S, Nieto FJ. Association of usual sleep duration with hypertension: the Sleep Heart Health Study Sleep. 2006; 29 (8): 1009 - 1014.
6. Albert WD. Epidemiology of Hypertension. Drug and Diseases update. 2013 www.medscape.com (February, 2014)
7. Hermida RC, Smolensky M. Chronotherapy of hypertension. Current Opinion Nephrology Hypertension 2004; 13: 501–550.
8. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC Study. Chronobiology. International. 2010: 27: 1629–1651.
9. Kario K, Schwartz JE, Pickering TG. Changes in nocturnal blood pressure dipping status in hypertensives by night-time dosing of alpha-adrenergic blocker, doxazosin; results from the HALT study. Hypertension 2000; 35: 787–794.
10. Neutel JM, Smith DH. The circadian pattern of blood pressure: cardiovascular risk and therapeutic opportunities. Current Opinion Nephrology Hypertension.1997; 6(3):250-6.
11. Basil NO, Esther NO, Jayne NAA. Diuretic Drugs Benefit Patients with Hypertension More with Night-time Dosing. Therapeutic Advances in Drug Safe; 2012; 3(6):273-278.
12. Ministry of Health, Zambia National Formulary Committee. Standard Treatment Guidelines, Essential Medicines List, Essential Laboratory Supplies for Zambia. 3rd edition, 2013. Lusaka, Zambia.
13. Ferdinand K, Ferdinand D. Race-based therapy for hypertension. Possible benefits and potential netfalls. Expert Review Cardiovascular Therapy. 2008; 6: 1357–1366.
14. Gombert T, Steichen O, Plonin P. Hypertensive disease in subjects born in Sub-Sahara Africa or in Europe referred to a hypertension unit. A cross-sectional study. Bull Academy of Natural Medicine. 2007; 191: 1745–1754, discussion 1754–1755.
16. McLennan WJ. Diuretics in elderly: how safe? British Medical Journal 1988; 19(296) no 6636 page 1551.
17. Khurship F, Aqil M, Alam MS, Kapur P,Pillai KK. Monitoring of adverse drug reactions associated with antihypertensive medicines at the University Teaching Hospital in New Delhi. DARU Journal of Pharmaceutical Sciences. 2012; 20:34
18. Sica D. Thiazide and loop diuretics. Clinical Cornerstone 2008; 4: 439–442.
19. National Center for Health Statistics. Quick Statistics: Percentage of adults who reported an average of 6 hours of sleep per 24-hour period, by sex and age group - United States. 2005; 54( 37): 933.
20. Hoevenaar-Blom MP, Spijkerman AMW, Kromhout D, Van den Berg JF, Verschuren WMM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN Study. SLEEP; 2011; 34(11):1487-1492.
21. Goma FM, Nzala SH, Olusegun B, Songolo P, Zyaambo C, Rudatsikira E, et al. prevalence of hypertension and its correlates in Lusaka urban district of Zambia: a population-based survey. International Archives of Medicine. 2011; 4:34 doi:10.1186/1755-7682-4-34.
22. Chikao I, Yoshihiko S, Toshiaki O, Kyoichi M, The fixed-dose combination of Losartan/HCTZ elicits potent BP lowering during night time in obese hypertensive patients. Journal of Clinical Medical Research. 2014; 6(1): 8–16.
23. Williams B, Lacouriccere Y, Schumacher H, Gosse P, Neutel JM. Antihypertensive efficacy of Telmisartan Vs Ramipril over the 24h dosing period, including the critical early morning hours: a pooled analysis of the PRISMA I and II randomised trial. Journal of Human Hypertension. 2009; 23, 610–619
24. Zeng J, Jia M, Ran H, Tang H, Zhang Y, Zhang J, et al. Fixed-combination of amlodipine and diuretic chronotherapy in the treatment of essential hypertension: improved blood pressure control with bedtime dosing-a multicenter, open-label randomised study. Hypertension Research. 2011; 34(6):767-72.
25. Portaluppi F, Michael HZ, Smolensky MH. Perspectives on the chronotherapy of hypertension based on results of MAPEC study. Chronobiology International. 2010; 27(8): 1652–1667.
26. Thomas M, Sakir U, Peter B. Management of Hypertension with fixed-dose combination of Candesartan and HCTZ: Patient perspectives and clinical utility. Vascular Health and Risk Management. 2009; 5 1043–1058
27. Wrzus C, Brandmaier AM, Von Oertzen T, Mu ̈ller V, Wagner GG. A New Approach for Assessing Sleep Duration and Postures from Ambulatory Accelerometry. PLoS ONE. 2012; 7(10): e48089. doi:10.1371/journal.pone.0048089, (April, 2014).
Published
2020-09-30
How to Cite
1.
Banda D, Muungo T, Lambwe N. Night-time Chronotherapy with Diuretics: Effect on Sleep Quality and Duration in Patients with Hypertension in Lusaka, Zambia. Journal of Agricultural and Biomedical Sciences [Internet]. 30Sep.2020 [cited 26Aug.2025];4(3):1-. Available from: https://journals.unza.zm/index.php/JABS/article/view/399
Section
Biomedical Sciences
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