Prognostic Role of Melatonin in the Assessment of the Hypertension Clinical Course

Abstract

Background: Sleep disorders are one of the most common problems in patients with arterial hypertension (AH). Circadian blood pressure (BP) cycles are most likely associated with the regulatory influence of melatonin. However, in patients with hypertension, if melatonin production decreases there is no adequate decrease of BP during sleep. The purpose of this study was to analyze the quality of sleep, chronotypes, and clinical, instrumental and laboratory parameters depending on urinary melatonin level (UML) to determine a prognosis for the course of AH in patients with insomnia. Methods and Results: We examined 178 patients with AH and insomnia aged from 30 to 70 years (mean age of 61.3±0.92 years). The AH diagnosis was based on 2018 ESC/ESH Guidelines for the management of arterial hypertension and Russian Society of Cardiology Clinical guidelines – Arterial hypertension in adults (2020). The insomnia diagnosis was based on the international classification of sleep disorders (2005). Using Multiple Regression Analysis, we determined the factors that influence the levels of SBP and DBP in AH patients with insomnia. AH patients with insomnia have a more severe clinical course of the disease, with frequent requests for medical help, altered BP variability, high anxiety level, high depression level and low level of the quality of life. The patients with AH and insomnia have low UML, which correlated with hypertension grade, chronotypes, high systolic and diastolic BP, BMI, high depression level, and low level of the quality of life in the physical and psychological domains. Conclusion: The developed methods for calculating the levels of SBP and DBP, depending on UML, body mass index, depression level, and PSQI, allow reliably evaluating and controlling the BP level in AH patients with insomnia.

Keywords

• arterial hypertension
• insomnia
• chronotype
• quality of life