Approaches for targeting blood pressure control in sleep disorders

One of the underappreciated causes of hypertension is disordered sleep. There have been a number of studies evaluating sleep in the context of blood pressure control, and these will be reviewed.

Original novel articles document that disruption of deep sleep stage, regardless of cause, if chronic, contributes to an increased risk for development of hypertension. Studies have evaluated disrupted sleep especially in older people requiring use of the bathroom at night and demonstrate higher risk of hypertension in such people. Correction of sleep apnea with continuous positive airway pressure (CPAP) reduces blood pressure in those who are adherent; however, as the reduction is only from 2 to 5 mmHg systolic, adjunctive medications are almost always needed. Use of angiotensin receptor blockers and some β-blockers has shown some improvement in blood pressure. Renal denervation has also been shown in a pilot study to offer benefit on blood pressure reduction.

Innovations of combined use of devices with certain classes of antihypertensive medications help reduce blood pressure in people with sleep disorders. CPAP alone provides only modest reduction in blood pressure; however, restoration of deep sleep reduces blood pressure and reduces variability.