The impact of insomnia on the development of arterial hypertension

Research objective: Insomnia is one of the most common sleep disorders and represents a significant public health concern, with chronic sleep disturbances increasing the risk of cardiovascular, metabolic, and psychiatric diseases. The aim of this study was to analyze the mechanisms through which insomnia contributes to the development of arterial hypertension, to discuss the importance of prevention and treatment of sleep disorders, and to present the adverse effects of the most commonly used antihypertensive medications. Methodology: A review of the scientific literature and review articles concerning insomnia, arterial hypertension, and antihypertensive pharmacotherapy was conducted. Publications available in PubMed, The Lancet, BMJ, Journal of Clinical Sleep Medicine, and Annals of Internal Medicine were analyzed. Current guidelines and studies regarding insomnia treatment and adverse effects associated with ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, beta-blockers, and diuretics were included. Main conclusions: The literature analysis demonstrated that chronic insomnia leads to excessive activation of the sympathetic nervous system, dysregulation of the hypothalamic–pituitary–adrenal axis, endothelial dysfunction, and increased oxidative stress and inflammation. These mechanisms contribute to elevated blood pressure and an increased risk of cardiovascular diseases. Cognitive behavioral therapy for insomnia (CBT-I) was identified as the most effective treatment for chronic insomnia. Furthermore, antihypertensive pharmacotherapy may be associated with numerous adverse effects, including cough related to ACE inhibitors, peripheral edema caused by calcium channel blockers, and electrolyte disturbances induced by diuretics. Insomnia is therefore a significant risk factor for the development of arterial hypertension and other chronic diseases. Application of the study: The findings highlight that early prevention, proper sleep hygiene, and effective treatment of sleep disorders may reduce the risk of cardiovascular complications. CBT-I should be regarded as the first-line treatment for chronic insomnia, whereas antihypertensive pharmacotherapy should be used cautiously and individually tailored to the patient. Originality/Novelty of the study: This review integrates the pathophysiological mechanisms linking insomnia to arterial hypertension with a practical discussion of insomnia treatment (notably CBT-I) and the adverse-effect profiles of major antihypertensive drug classes, providing a combined perspective on prevention, sleep management, and pharmacotherapy

Adverse effect · Antihypertensive drug · Blood pressure · Insomnia · Pharmacotherapy · Risk factor · Sleep disorder · Sleep medicine · Obstructive Sleep Apnea Research · Sleep and related disorders · Sleep and Wakefulness Research

• Management of Chronic Insomnia Disorder in Adults

  Open Access•Amir Qaseem, Devan Kansagara et al.•Annals of Internal Medicine•2016

  Add to list

• Impact of sleep debt on metabolic and endocrine function

  Open Access•Karine Spiegel, Rachel Leproult et al.•The Lancet•1999

  Add to list

• Epidemiology of insomnia

  Open Access•Maurice M Ohayon•Sleep Medicine Reviews•2002

  Add to list

• Short- and long-term health consequences of sleep disruption

  Open Access•Goran Medic, Micheline Wille et al.•Nature and Science of Sleep•2017

  Add to list

• Sleep Health

  Daniel J Buysse•Sleep•2014

  Add to list

• Why Sleep Is Important for Health

  Michael R Irwin•Annual Review of Psychology•2015

  Add to list