The effect of night time diuretic chronotherapy on quality and duration of sleep among Zambian hypertensive patients

Abstract

Poor sleep plays an important role in the prevalence of hypertension. It increases the prevalence rate to 60%. It is thought that sleep regulates stress hormones and helps nervous system. Overtime, lack of sleep hurt the body ability to regulate stress hormones, leading to high blood pressure. The night time dosing of blood pressure lowering drugs have 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. Methods: The sample consisted of 43 patients with hypertension and on diuretic, 25 of whom were taking their medication in the evening at 10 PM and 18 were in the 10 AM dosing schedule. The BP was measured with cuff sphygmomanometer at enrolment and follow-ups. The quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) score while the duration of sleep was measured with Epworth Sleepiness Scale (ESS) score at enrolment and follow-ups. A PSQI score of less than 5 indicated good sleeps while an ESS score of 1-6 as a good duration of sleep. Results: Overall, 43 were included in the analysis. The 10AM group had 18 (41.8%), while the 10PM group had 25 (58.2%) at enrolment. The study recruited more women (72.0%) and the majority were on hydrochlorothiazide and amiloride combination (72.0%). The 10PM dosing showed significant differences in quality of sleep with p-value of 0.010 at 12 weeks follow-up. The duration of sleep did not show significant differences between the groups with p-value of 0.215. The blood pressure lowering was significant in the 10PM group with p-value of 0.020 at 12 weeks follow-up. Conclusions: The study suggested that the 10PM dosing of diuretics in hypertensive patients and the diuretic effect does not affect the quality and duration of sleep. Further, 10PM dosing lowers the blood pressure significantly compared with 10AM.