Treating Insomnia May Improve Blood Pressure Control

MedicalResearch.com Interview with:

Haicong Li Director and Professor, Department of Geriatrics China-Japan Friendship Hospital Beijing, China.

Dr. Haicong Li

Haicong Li
Director and Professor, Department of Geriatrics
China-Japan Friendship Hospital
Beijing, China. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Based on our clinical observations over the years, we noticed two common
phenomena:

  • One is that the occurrence of hypertension in patients with
    chronic sleep disorders tend to be higher than those with normal sleep
    conditions;
  • The other is that the blood pressure of some hypertensive
    patients cannot be lowered to normal level even with anti-hypertensive
    treatments, of which group many have sleep disorders.

So we hypothesized that the improvement of insomnia can effectively help lower the of
hypertensive patients and the combination of anti-hypertensive medication
and sedative-hypnotic drugs can achieve better therapeutic effects.
In our experiment, 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 antihypertensive treatment
with Estazolam and the control group (200 cases) received standard
antihypertensive treatment with placebo. We measured the sedentary
diastolic (SiSBP) and systolic blood pressure (SiDBP) before the treatment
and every 7 days during the experiment. To assess the sleep quality and
anxiety and depression levels of patients, we reported the scores of the
Pittsburgh Sleep Quality Index (PSQI), the Hamilton Anxiety Rating Scale
(HAMA) and the Hamilton Depression Scale-17 (HAMD 17) at the same time
points.

At the conclusion of the experiment, PSQI, HAMA, and HAMD17
scores 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 group (P <
0.001). The blood pressure of the treatment group showed significant improvement
throughout the experiment. By Day 28, the decrease of SiSBP and SiDBP in
the treatment group was significantly greater than that of the control group
(SiSBP: 10.5±3.9 vs. 3.4±2.5; DiSBP: 8.1±3.6 vs. 2.7±2.1, mmHg, P<0.001)
and the compliance rate of goal BP (<140/90 mmHg) was 74.8% with
Estazolam, compared to 50.5% with placebo (P<0.001).

Thus, our findings indicated that the improvement of insomnia can significantly help lower the blood pressure in hypertensive patients.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: The current study suggests that the improvement of sleep condition can
effectively help lower the blood pressure in hypertensive patients. It is hoped that in
light of the current results, doctors can pay more attention to the sleep
condition of hypertensive patients as well as their anxiety and depression
levels. In regard to efficacy, the combination of anti-hypertensive
medication and sedative-hypnotic drugs can achieve better therapeutic
effects, compared with using only anti-hypertensive treatment.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: To further prove and support the positive correlation between insomnia
and hypertension we observed in this study, a larger scale and multi-center
research can be performed. Also, as pointed out in the discussion part,
another direction would be to study the withdrawal reactions of Estazolam
and observe the occurrences of rebound insomnia and the changes of BP
patterns, which can be significant in the long-term management of BP for
hypertensive patients. In this research, we observed the improvement of
the Hamilton Depression Scale-17 (HAMD 17 ) scores in hypertensive patients
with insomnia who received sleep treatment. More investigation is needed
to elucidate the influence of depression on BP levels and to confirm the
antidepressive effects of Estazolam.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Li, Y., Yang, Y., Li, Q., Yang, X., Wang, Y., Ku, W. L. and Li, H. (2016), The impact of the improvement of insomnia on blood pressure in hypertensive patients. Journal of Sleep Research. doi: 10.1111/jsr.12411

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