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Insufficient and poor sleep on a chronic basis raises blood pressure (BP), the risk of hypertension and cardiovascular disease which in turn further leads to sleep disturbances.In a prospective observational study we tested the hypothesis whether intensification of antihypertensive therapy improves sleep quality Patients with arterial hypertension on multiple drug medication were followed for 3 months if according to the physician‘s perception BP control was insufficient or patients profit from simplification of drug therapy. Intensification of antihypertensive therapy consisted of switching from multiple pills per day to a single pill combination. Office BP readings and out-of-BP measurements were monitored. The abbreviated PITTSBURGH SLEEP INVENTORY (PSQI) was applied to assess sleep duration and quality Results: In 229 patients (mean age 65 years, 62 % were males) office BP decreased from 158 ± 15/92 ± 8 to 132 ± 10/87 ± 8 mmHg (both p<0.001). In parallel, sleep quality improved in 45 % and remained equal/worse in 53 % (p<0.001) after 3 months In patients whose sleep quality improved (N=95) office BP dropped from 160±15/94±10 to 131±8.6/80±7 mmHg (both p<0.001), whereas in patients with equal or worse sleep quality (N=119) BP fell only from 156±15/90±5 to 133±10/80±8 mmHg (both p<0.001). BP fall was significantly greater in those with improved sleep quality as opposed to those with equal/worse sleep quality after 3 months of therapy (4.98±1.5/2.71±0.94 mmHg, p<0.001 and p=0.005, respectively). Change in out-office systolic BP measurements was greater in those with improved as opposed to those with equal/worse sleep quality (5.80±1.9 mmHg, p=0.003). Thus, intensification of antihypertensive treatment by using single pill combination resulted in significant fall in BP accompanied by an improvement in sleep quality. Abstract Sleep quality improved after intensified blood pressure lowering therapy.docx

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