Review Article

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

Table 1

Characteristics of cohort studies in the meta-analysis.

AuthorYearCountryFollow-upyearsSampleAge range (or mean age)Insomnia assessmentInsomnia typeHypertension assessmentNote

Suka et al. [26]2003Japan4923740–55 ySleep questionnaireDIS, DMS(1) SBP ≥ 140 mmHg and (or) DBP ≥ 90 mmHgBaseline insomnia
(2) Antihypertensive treatmentNOS rating: 6
Phillips and Mannino [27]2007USA68,75745–69 ySleep questionnaireDFA, SCD, NRS(1) SBP ≥ 160 mmHg and (or) DBP ≥ 95 mmHgBaseline insomnia
(2) Antihypertensive treatmentNOS rating: 8
Phillips et al. [28]2009USA61,41964–91 ySleep questionnaireD4FA, EMA, SCD(1) SBP ≥ 140 mmHg and (or) DBP ≥ 90 mmHgBaseline insomnia
(2) Antihypertensive treatment (3) Self-reported hypertensionNOS rating: 7
Knutson et al. [29]2009USA553535–45 ySleep questionnaireDMS(1) SBP≥140 mmHg and (or) DBP ≥ 90 mmHgBaseline insomnia
(2) Antihypertensive treatmentNOS rating: 6
Gangwisch et al. [30]2010USA104,91332–86 ySleep questionnaireDIS, DMS, EMA(1) SBP≥140 mmHg and (or) DBP ≥ 90 mmHgBaseline insomnia
(2) Self-reported hypertension (3) Physician or hospital diagnosisNOS rating: 7
Troxel et al. [31]2010USA381245–74 ySleep questionnaireDIS, NRS(1) SBP ≥ 130 mmHg and (or) DBP ≥ 85 mmHgBaseline insomnia
(2) Antihypertensive treatmentNOS rating: 6
Rod et al. [23]2011France2016,98936–52 ySleep questionnaireDFA, DMS, EMA(1) Self-reported hypertensionBaseline insomnia
NOS rating: 6
Fernandez-Mendoza et al. [30]2012USA7.5786M = 47.5 ySleep questionnaireDFA, DMS, EMA, NRS, chronic insomnia(1) SBP ≥ 140 mmHg and (or) DBP ≥ 90 mmHgBaseline insomnia
(2) Self-reported hypertension (3) Antihypertensive treatmentNOS rating: 7
Pedraza et al. [31]2012USA31,085≥75 ySleep questionnaireDIS, DMS, NRS(1) SBP ≥ 140 mmHg and (or) DBP ≥ 90 mmHgBaseline HTN
(2) Self-reported hypertension
(3) Physician or hospital diagnosis
NOS rating: 6
Singareddy et al. [32]2012USA7.51,246≥20 ySleep questionnaireDFA, DMS, EMA, NRS(1) Antihypertensive treatmentBaseline HTN
(2) Self-reported hypertensionNOS rating: 6
Zhang et al. [19]2012China5.22,316M = 47.5 yDSM-IV, ICSD-1, ICD-10DIS, DMS, EMA(1) Self-reported hypertensionBaseline insomnia
NOS rating: 8
Jaussent et al. [33]2013France65,49465–94 ySleep questionnaireEds, DIS, DMS, EMA(1) SBP≥160 mmHg and (or) DBP ≥ 95 mmHgBaseline insomnia
(2) Antihypertensive treatmentNOS rating: 6
Haaramo et al. [34]2014Finland56,47740–60 ySleep questionnaireDFA, DMS(1) Antihypertensive treatmentBaseline insomnia
NOS rating: 7
Sivertsen et al. [35]2014Norway1124,71520–89 yDSM-IVDMS, DIS, NRS(1) Self-reported hypertensionBaseline insomnia
NOS rating: 8
Jackowska and Steptoe [36]2015UK43,937≥50 ySleep questionnaireDFA, DMS, EMA(1) SBP ≥ 140 mmHg and (or) DBP ≥ 90 mmHgBaseline insomnia
(2) Antihypertensive treatmentNOS rating: 6
Cheng et al. [12]2015USA1967M = 43.1 ySleep questionnaireDFA, DMS(1) Self-reported hypertensionBaseline insomnia
NOS rating: 6
Clark et al. [37]2016Finland170,04918–69 yDSM-IVDFA, DMS, EMA, NRS(1) Antihypertensive treatmentBaseline insomnia
NOS rating: 8
Leigh et al. [38]2016Australia1510,72170–75 ySleep questionnaireEMA, DIS(1) Self-reported hypertensionBaseline HTN
NOS rating: 6
Lin et al. [24]2016Taiwan544,559>20 y1.ICD-9DFA, DMS, EMA(1) ICD-9Baseline insomnia
NOS rating: 7
Dong and Yang [38]2019USA818,123≥50 ySleep questionnaireDFA, DMS, EMA, NRS(1) SBP ≥ 140 mmHg and (or) DBP ≥ 90 mmHgBaseline insomnia
(2) Antihypertensive treatmentNOS rating: 6
Garbarino and Magnavita [39]2019Italy5234M = 36 ySleep questionnaireDIS, EMA, NRS(1) SBP ≥ 130 mmHg and (or) DBP ≥ 85 mmHgBaseline insomnia NOS rating: 5
Rahim et al. [40]2020Canada122,07935–69 ySleep questionnaireDIS, DMS, NRS(1) ICD-9, ICD-10Baseline insomnia NOS rating: 6
Li et al. [41]2020USA66,96518–74 yWomen’s Health Initiative Insomnia Rating Scale (WHIIRS)NA(1) SBP ≥ 140 mmHg and (or) DBP ≥ 90 mmHgBaseline insomnia NOS rating: 7
(2) Antihypertensive treatment

DBP = diastolic blood pressure; DFA, difficulty falling asleep; DIS, difficulty initiating sleep; DMS, difficulty maintaining sleep; DSM, Diagnostic and Statistical Manual of Mental Disorders; EMA, early morning awakening; HTN = hypertension; ICSD, International Classification of Sleep Disorders; ICD, International Classification of Diseases; NA = not available; NOS = Newcastle-Ottawa Scale; NRS, non-restorative sleep; SBP = systolic blood pressure.