Early evidence for inclusion of practice of morning ingestion of water as a lifestyle modification (adjuvant) in management of hypertension in patients of diabetes mellitus

Abstract

Objectives: Researches reflecting the role of water in blood pressure (BP) regulation are documented to a lesser degree. A holistic approach, combining standard treatment protocols with lifestyle modifications, serves as the best approach to check the increasing prevalence and coexistence of hypertension (HTN) and diabetes mellitus. Thus, we aim to access the effects of morning ingestion of water on HTN in diabetic individuals when practiced adjuvant with antihypertensive and oral hypoglycemic medications. Materials and Methods: We conducted a prospective cohort with 68 patients having diabetes mellitus and HTN, with 34 participants each in the study and control group. The control group followed standard treatment protocol for HTN and diabetes mellitus. Study group in adjuvant to above practiced drinking 0.75–1 L of water altogether (within 5–10 min) in the morning immediately after waking up in a sitting (crossed leg or squatting) position. The changes in BP and other biochemical parameters were recorded. Results: For the study group (n = 34), repeated measured analysis of variance revealed a statistically significant lowering of systolic BP (SBP): F (2, 66) = 17.17, P ≤ 0.0001 and diastolic BP (DBP): F (2, 66) = 7.31, P = 0.0014. Moreover, post hoc analysis with Tukey–Kramer multiple comparisons found that the mean difference was statistically significant for baseline and end of 2 months – SBP: (14 [95% confidence interval, CI 8.23–19.77] mmHg, P < 0.001) and DBP: (6.35 (95% CI 2.22–10.48) mmHg, P < 0.01). The SBP and DBP at baseline versus the end of 2 months were 143.76 (13.40) versus 129.76 (14.27) mmHg and 84.35 (12.01) versus 78 (8.90) mmHg, respectively. In the study group, regression in the stage of HTN was observed where ten of 15 patients and 11 of 19 patients recovered from Stage I and Stage II HTN, respectively. Furthermore, 67.6% of the study group achieved a target BP of <140/90 mmHg at the end of 2 months. Conclusion: The practice of morning ingestion of water does affect BP regulation and this practice can be a new potential lifestyle modification adjuvant with standard treatment guidelines for management of HTN in patients of diabetes mellitus.