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Poor sleep quality related to resistant hypertension
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Poor sleep quality may be associated with a twofold increase in the probability of having resistant hypertension. However, when depressive symptoms are factored in, this association may be mediated, researchers reported at the American Heart Association’s High Blood Pressure Research 2012 Scientific Sessions.
Researchers presented data on 234 patients (mean age, 58 years) from the hypertension outpatient unit at University of Pisa, Italy. At baseline, the patients’ mean BMI was 26; 60% had hypercholesterolemia; 24% were taking antihypertensive medications; 15% reported smoking; 12% had a history of previous CV events; and 8% had diabetes.
The mean sleep duration of the patients was 6.4 hours and 49% of patients had sleep short duration (<6 hours). Prevalence of short sleep duration was similar in both men and women.
Compared with men, women had higher Pittsburgh Sleep Quality Index scores (5.2 vs. 3.6; P=.03), higher Beck Depression Inventory scores (4.5 vs. 1.8; P=.006), higher prevalence of poor sleep quality (46% vs. 30%; P=.01) and higher prevalence of depressive symptoms (20% vs. 7%; P=.003).
Multiple logistic regression analysis, including age, sex, obesity, diabetes, previous CV events, sleep duration and use of hypnotic drugs, revealed an independent association between poor sleep quality and resistant hypertension (OR=2.2; 95% CI, 1.1-5.3). However, the association was no longer significant when depressive symptoms were included in the model (P=.12), according to the abstract. For this study, resistant hypertension was defined as office BP values exceeding 140/90 mm Hg with use of three or more antihypertensive drugs or controlled BP with use of four or more drugs including a diuretic.
In addition, patients with resistant hypertension (15%) had higher Pittsburgh Sleep Quality Index scores compared with patients without resistant hypertension (5.8 vs. 4.1; P=.03), but this association was only observed in women. The association between Beck Depression Inventory scores and resistant hypertension was similar between men and women.
For more information:
Bruno RM. Abstract #63. Presented at: the American Heart Association’s High Blood Pressure Research 2012 Scientific Sessions; Sept. 19-22, 2012; Washington, D.C.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Richard A. Stein, MD
Results showed that the phenomenon of poor sleep quality is higher in women with resistant hypertension than in men, and is commonly associated with depression. But, if you factor depression into the equation, then, by itself, the sleep abnormality loses its significance.
Poor sleep quality by itself is a poor quality of life issue.It is important to take a brief sleep history of patients to determine if they have poor sleep quality because that would be another thing you might want to treat, in terms of improving a patient’s quality of life.
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