The Association between Hypertension and Insomnia: A Bidirectional Meta-Analysis of Prospective Cohort Studies

Studies on bidirectional associations between hypertension and insomnia are inconclusive. The purpose of this meta-analysis was to systematically review and summarize the current evidence from epidemiological studies that evaluated this relationship.

PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP databases were searched for studies published up to May 2021. Prospective cohort studies that reported the relationship between hypertension and insomnia in adults were included. Data were extracted or provided by the authors according to the prevalence rate, incidence rate, unadjusted or adjusted odds ratio (OR), and 95% confidence interval (CI). Heterogeneity was assessed by I2 statistics. ORs were pooled by using random-effects models.

A total of 23 prospective studies were identified. Twenty cohort studies recorded OR-adjusted value with the outcome for hypertension (OR = 1.11, 95% CI: 1.07-1.16; I2 = 83.9%), and three cohort studies reported OR-adjusted value with the outcome for insomnia (OR = 1.20, 95%CI: 1.08-1.32; I2 = 35.1%). Subgroup analysis showed that early morning awakening and composite insomnia were significantly associated with hypertension.

The result indicates a possible bidirectional association between hypertension and insomnia. Early identification and prevention of insomnia in hypertension patients are needed, and vice versa.