WOMEN, DEPRESSION, SLEEP AND RESISTANT HYPERTENSION

There is much evidence showing that sleep is very important for normal bodily function, including functions of the sympathetic nervous system and also endocrine system. In my clinic, probably the most important reason for poor BP control, is lack of sleep, either duration of sleep or quality of sleep. So whenever I see a patient whose BP has gone out of good control, asking about sleep, duration and quality, often explains the poor control, and getting them to sleep / rest better often helps control.
At the recently concluded meeting of the American Heart Association High Blood Pressure Research Annual Scientific meeting in Washington, Dr Rosa Bruno, from the University of Pisa, Italy presented a paper entitled " The relation between poor sleep quality and Hypertension". She and colleague studied 234 patients from a hypertension clinic, and co-related their BP control with a sleep questionnaire, and also a mental status questionnaire about depression. They found that 15% of their population had resistant hypertension ( defined as uncontrolled BP with 3 or more medications. They found that those with resistant hypertension were mainly females ( although their study population had equal numbers of males and females , who did not sleep well by the Pittsbrugh Sleep score, and who were depressed..
The obvious explanation being there poor sleep activates the sympathetic nervous system, and also increases serum cortisol levels, causing persistent rise in BP. Treating their depression and sleep becomes an important part of BP management.
It is important to note that this is largely an observational study and so cannot be definitive. However, it adds into the large body of evidence that we now have between sleep, depression and poor BP control.