Effect of Morning Versus Evening Perindopril on Blood Pressure Control in People With Type 2 Diabetes

Background: Renin-angiotensin system antagonists represent the mainstay of blood pressure (BP) lowering treatment options in people with diabetes. ACE inhibitors have a long half-life and offer the advantage of a single daily dose, usually empirically taken in the morning.

Objective: We assessed the influence of time of administration of ACE inhibitors on circadian BP control in type 2 diabetes (T2D) patients with stage 1 hypertension.

Methods: Twenty T2D patients (9 being women) with a mean age of 58.7 years, diagnosed with stage 1 of hypertension and naive to BP lowering medications, were included. They were randomly allocated to receive perindopril 10 mg/day as a monotherapy either in the morning or in the evening for 28 days, with crossover without washout period on day 29th and additional 28 days follow-up. A 24-hour ambulatory BP monitoring (ABPM) was performed at baseline, days 28 and 56.

Inclusion criteria

• Type 2 diabetes
• Grade 1 hypertension
• Informed consent

Exclusion criteria

• estimated creatinine clearance≤ 60ml/min
• White coat hypertension after initial 24 hour ABPM
• Previous antihypertensive treatment
• Pregnant women
• Individuals working during the night
• Hyperkalemia