Pragmatic Trials Collaborative

Completed Trials

Bedtime Diuretics (a BedMed sub-study)

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Summary

Many physicians believe that blood pressure lowering medications known as "diuretics" can't be recommended for bedtime use because they might cause extra overnight urine production that could disrupt sleep. As some participants in the BedMed trial were switching a single well established morning blood pressure medication to bedtime, we took the opportunity to compare the experience of those switching a diuretic to bedtime, with those switching a non-diuretic to bedtime. Before making the switch, 1.5% of morning diuretic users experienced nocturia (getting out of bed to urinate) as a major burden. When these morning diuretic users switched their diuretic to bedtime instead, nocturia was more frequent, becoming a major burden for 15.6%. Similar individuals switching other types of blood pressure medication from morning to bedtime experienced no increase in nocturia, but they still chose not to continue with bedtime use 10.2% of the time (for other reasons – most commonly forgetting to take their medication). Due to the extra burden of nocturia, more diuretic users chose not to continue with bedtime use, but it was still the minority of participants (22.7%).

Bottom Line

When switching a diuretic to bedtime, 14.1% of people will newly experience nocturia as a major burden. However, 77.3% can successfully make the switch (should there be a reason to do so).