The TIME study finds no difference between morning and evening administration of antihypertensive medications in terms of preventing major adverse cardiovascular events.

The absolute benefit of blood pressure reduction on cardiovascular risk does not differ according to whether or not people have type 2 diabetes, shows an individual participant data meta-analysis.

Analysis of the affected genes indicated that “verapamil regulates the thioredoxin system and promotes an antioxidative, anti-apoptotic and immunomodulatory gene expression profile in human islets,” they say. medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group Nat Commun 2022; 13 : 1159

Remission was defined as having glycated hemoglobin (HbA1c) below 48 mmol/mol (6.5%) without use of diabetes medications.

Rahimi et al conclude: “The evidence that blood pressure reduction is linked to diabetes presents clinicians and health policy makers with an opportunity to modify disease risk, for instance, either through the use of appropriate antihypertensive medications or by promoting lifestyle behaviours known to reduce blood pressure such as by maintaining a healthy weight through physical activity and a balanced diet.”

During 2 years of follow-up, people who had not received blood pressure or lipid-lowering medications within a year of requiring them were significantly less likely to achieve control of these risk factors than those who had received treatment in a more timely fashion.

Blood pressure falls markedly when people with type 2 diabetes undertake a very-low-calorie diet, and immediate withdrawal of antihypertensive medications has few ill effects, say the DiRECT investigators.

They also point out the “extensive out-of-study use of lipid-lowering and antihypertensive medications, provision of a less intensive lifestyle intervention to all DPPOS participants, and increased out-of-study metformin use over time, which may both have limited the apparent effects of the interventions and have been valuable preventive strategies.”

Two notable trials attempted to promote anti-inflammatory molecules, by giving interferon-α (to boost interleukin [IL]-4 and IL-10) and the endogenous anti-inflammatory protein alpha‐1 antitrypsin, both of which appeared promising in preclinical research.

A large randomized trial may have settled the question of whether it is best to take blood pressure medications in the morning or evening.

We don't expect blood pressure to stay down if we stop the anti-hypertensive.

Being in receipt of glucose-lowering or antihypertensive medications was perversely associated with a reduced likelihood of achieving HbA1c and SBP targets, respectively, but the researchers believe this “may be explained by a tendency amongst doctors to prescribe medication in response to a failure to reach targets.”

They were also provided with guidance on the appointment content, which included: setting expectations and reviewing progress; measurements, eg, weight, blood pressure, and glucose; a review of the need for anti-diabetes and anti-hypertensive medication according to guidelines; provision of formula diet; and appointment workbooks to guide further discussion with the participant.

Principal investigator Peter Rossing (University of Copenhagen, Denmark) suggested that the team might have achieved a positive result had they been able to follow up more patients for longer, pointing to the scale and duration of cardiovascular outcomes trials for modern diabetes medications.

Among these people, the risk for developing OSA was highest in those who were male, older, overweight or obese, had depression or atrial fibrillation, or used lipid-lowering or antihypertensive medications.

Taken together, these findings raise the question of whether bedtime dosing of antihypertensive medications could reduce the risk for mortality and adverse kidney outcomes in people with type 1 diabetes and nocturnal non-dipping, said Hjortkjaer.

In the wake of the revised blood pressure targets, Editorial Board member Jay Shubrook and Advisory Board member Robert Chilton discuss clinical approaches to get hypertensive diabetes patients to target more consistently (12:29).

Had a combination of hypertensive nephrosclerosis, a fair amount of people with IgA nephropathy, and typical to chronic kidney disease, a mishmash of other diseases that are not fully diagnosed.

Besides taking ARBs, about two-thirds of the patients were also taking calcium channel blockers and a quarter were taking diuretics, with smaller proportions taking alpha-blockers, beta-blockers, and other antihypertensive medications.

Extrapolated to the population of England, the costs of intensively treating all diabetes patients with the trial medications were equivalent to “a small fraction of the NHS's spending plans” [89].