Do patients who use once-daily thiazide diuretics tolerate bedtime dosing?
A total of 77% of patients who switched daily dosing of single-dose thiazide diuretic medication from morning to night self-reported adherence to nighttime dosing after 6 months, despite the fact that nocturia was more frequent. This was only 13% lower than among the group whose regimen didn’t include a thiazide diuretic. The study may overestimate the tolerability of nighttime diuretic dosing because patients who had nocturia, or had already tried and didn’t tolerate nighttime dosing, would be unlikely to have been willing to participate in the study.
Plan de l'etude:
Outpatient (primary care)
Adult primary care patients in Canada were invited to participate in a randomized controlled trial (BedMed) if they were taking a single tablet for daily dosing of antihypertensive mediation that included a thiazide diuretic. They were randomized to either switch to nighttime dosing or to continue morning dosing. This report describes the self-reported adherence of a prospective cohort of 579 patients within the trial who switched to nighttime dosing and compares those whose regimen included a thiazide diuretic with those whose regimen didn’t. At 6 months, 77% of patients using diuretics reported adherence to nighttime dosing versus 90% of those whose regimen didn’t include diuretics (difference 13%; 95% CI 6 - 20; P < .0001; number needed to treat to harm [NNTH] = 8). Nocturia was the reason given for nonadherence by 56% (25/45) of diuretic users. Of those still adherent (153 diuretic users and 301 nondiuretic users), the median difference in nighttime urination was 1.0 urinations per week. Among the entire cohort (ie, both adherent and nonadherent patients), 14% more diuretics users considered nocturia to be a major burden (15.6% vs 1.3%; 9% - 21%; NNTH = 7).
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo