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Sleep Med. 2013 Nov;14(11):1157-63. doi: 10.1016/j.sleep.2013.04.020. Epub 2013 Aug 28.

Poor sleep quality and resistant hypertension.

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Institute of Clinical Physiology-CNR, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.



We aimed to determine the relationship between sleep quality and treatment-resistant hypertension (RH).


In our cross-sectional cohort study, 270 consecutive essential hypertensive patients were recruited at the Outpatient Hypertension Unit, University of Pisa, Italy. The Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI-Y2) were administered to all subjects. RH was defined as office blood pressure (BP) >140/90 mmHg with three or more antihypertensive drugs or controlled BP with four or more drugs. Poor sleep quality was defined as PSQI >5, depressive symptoms as BDI >10, and trait anxiety as STAI-Y2 >40. Patients with other sleep disorders were excluded.


Complete data were available for 222 patients (50.9% men; mean age, 56.6±12.5 y; RH, 14.9%). Poor sleep quality had a prevalence of 38.2% in the overall population. RH was associated with poor sleep quality, increased sleep latency and reduced sleep efficiency. No significant relationship was found between RH and short sleep duration or depressive symptoms and trait anxiety. Poor sleep quality was more prevalent in resistant vs nonresistant hypertensive women (70.6% vs 40.2%; P=.02) but not in resistant vs nonresistant men (43.8% vs 29.2%; P=.24). In women poor sleep quality was an independent predictor of RH, even after adjustment for cardiovascular and psychiatric comorbidities (odds ratio [OR], 5.3 [confidence interval {CI}, 1.1-27.6), explaining 4.7% of its variance. In men age, diabetes mellitus (DM), and obesity were the only variables associated with RH.


Poor sleep quality is significantly associated with resistance to treatment in hypertensive women, independent of cardiovascular and psychiatric confounders.


Gender differences; Hypertension; Insomnia; Resistant hypertension; Sleep disorders; Sleep quality

[Indexed for MEDLINE]

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