The impact of the improvement of insomnia on blood pressure in hypertensive patients

Abstract

Summary This study investigated the impact of the improvement of insomnia on the blood pressure levels of hypertensive patients. A total of 402 patients with a diagnosis of insomnia and hypertension were selected and randomly divided into two groups. The treatment group (202 cases) received standard anti‐hypertensive treatment with Estazolam, and the control group (200 cases) received standard anti‐hypertensive treatment with placebo. The sedentary diastolic and systolic blood pressures were measured before the treatment and every 7 days during the experiment. To assess the sleep quality and anxiety and depression levels of patients, the scores of the Pittsburgh Sleep Quality Index, the Hamilton Anxiety Rating Scale and the Hamilton Depression Scale‐17 were reported at the same time points. At the conclusion of the experiment, the Pittsburgh Sleep Quality Index, Hamilton Anxiety Rating Scale and Hamilton Depression Scale‐17 scores of the treatment group were significantly lower than those of the control group (P < 0.001). The insomnia treatment efficacy of Estazolam in the treatment group was 67.3%, significantly higher than that (14.0%) of the control (P < 0.001). The blood pressure of the treatment group showed significant improvement throughout the experiment. By Day 28, the decrease of sedentary diastolic and systolic blood pressures in the treatment group was significantly greater than that of the control (sedentary systolic blood pressure: 10.5 ± 3.9 versus 3.4 ± 2.5 mmHg; sedentary diastolic blood pressure: 8.1 ± 3.6 versus 2.7 ± 2.1 mmHg, P < 0.001), and the compliance rate of goal blood pressure (< 140/90 mmHg) was 74.8% with Estazolam, compared with 50.5% with placebo (P < 0.001). Thus, the current findings indicated that the improvement of insomnia can significantly help lower blood pressure in hypertensive patients.

Insomnia and hypertension: A misty landscape

“…Huang and associates demonstrated that a non‐benzodiazepine (zolpidem) significantly influenced the conversion of non‐dipping to dipping status when used for the management of insomnia . Li et al conducted a randomized, placebo‐controlled trial to evaluate the impact of estazolam on BP outcomes in patients with insomnia. Overall, 402 Chinese with insomnia and hypertension were randomly assigned to estazolam 1 mg/d (n = 202) and standard antihypertensive treatment or the later and placebo (n = 200).…”

“…18 Huang and associates demonstrated that a non-benzodiazepine (zolpidem) significantly influenced the conversion of non-dipping to dipping status when used for the management of insomnia. 19 Li et al 20 Of note, a post hoc analysis suggested that suvorexant resulted in a greater reduction in morning systolic ABPM compared with placebo among participants with baseline morning systolic ABPM > 150 mm Hg (P = 0.037). The most interesting finding of the study, however, may be the high prevalence of masked hypertension in this population (47% in both groups).…”

A message from the new editor in chief

“…Li et al . () report data from a study which compared standard antihypertensive treatment combined with a standard hypnotic in the United States (estazolam) with a control group who also received standard hypertensive treatment combined with placebo. This 4‐week treatment study showed that blood pressure decreased much more strongly in patients treated successfully with the hypnotic compared to the placebo condition.…”

“…This allowed, as reported by the authors, more specific conclusions with respect to the influence of age and sex on the distribution of spectral power in insomniacs and good sleepers. Li et al (2017) report data from a study which compared standard antihypertensive treatment combined with a standard hypnotic in the United States (estazolam) with a control group who also received standard hypertensive treatment combined with placebo. This 4-week treatment study showed that blood pressure decreased much more strongly in patients ª 2017 European Sleep Research Society treated successfully with the hypnotic compared to the placebo condition.…”

A behavioral intervention for insomnia improves blood pressure

“…This BP-lowering effect may have been caused by an improvement in sleep 4 or by reducing stress/anxiety and SNS arousal 5 . This approach should be tested in individuals with comorbid hypertension and insomnia.…”