Diagnostic and Therapeutic Approach to Sleep Disorders, High Blood Pressure and Cardiovascular Diseases: A Consensus Document by the Italian Society of Hypertension (SIIA)

Abstract

Hypertension is a major contributor to fatal/nonfatal cardiovascular diseases, and timely identification and appropriate management of factors affecting hypertension and its control are mandatory public health issues. By inducing neurohormonal alterations and metabolic impairment, sleep disorders have an impact on a variety of cardiovascular risk factors, including hypertension, and ultimately increase the risk of cardiovascular events. There is evidence that qualitative and quantitative sleep disorders are associated with resistant hypertension and with impaired circadian blood pressure variations. However, sleep disturbances are often unrecognized, or heterogeneity exists in their management by non-specialists in the field. This document by the Italian Society of Hypertension summarizes the updated evidence linking sleep disorders to hypertension and cardiovascular diseases, the major underlying mechanisms, and the possible management strategies. A simplified, evidence-based diagnostic and therapeutic algorithm for comorbid hypertension and common sleep disorders, namely obstructive sleep apnoea and insomnia, is proposed.

Insomnia: risk factors, sex- and age-specific features, and therapeutic approaches

“…Необходимо отметить, что снотворные препараты различаются по срокам выведения, периоду полувыведения и принципу действия. Некоторые снотворные средства, например бензодиазепины первого поколения, имеют больше шансов вызвать остаточный седативный эффект по утрам, особенно после длительного применения, и/или у пожилых людей, у которых они также могут увеличить риск падений, эпизодов спутанности сознания и нарушения когнитивных функций [91].…”

TIMES TO ACT. Italian-Spanish-Polish-Uzbek Expert Forum Position Paper 2022. Dyslipidemia and arterial hypertension: The two most important and modifiable risk factors in clinical practice

“…Irrespective of which country was analyzed, in each of the countries, the percentage of patients with hypertension ranges from 26% to 40% and patients with hypercholesterolemia -from 15% to 53%. In total, in four of these countries it was estimated that 17-32% of patients were obese, 18-21% smoked cigarettes, 6-15% had diabetes, 7-17% suffered from chronic kidney disease, and at least 1-3% had heart failure [16][17][18]. When analyzing medical care that targets the most important cardiovascular risk factors, the biggest problem is the relatively small number of cardiologists per 10,000 inhabitants in Uzbekistan, there were a small number of all medical doctors in Poland and Uzbekistan, a high prevalence of obesity and diabetes in Uzbekistan, a high prevalence of chronic kidney disease in Spain and too many active smokers in all the countries [19][20][21].…”

Peculiarities of insomnia in men and women at different age periods

“…Необходимо отметить, что снотворные препараты различаются по срокам выведения, периоду полувыведения и принципу действия. Некоторые снотворные средства (например, бензодиазепины первого поколения) имеют больше шансов вызвать остаточный седативный эффект по утрам, особенно после длительного применения и (или) у пожилых людей, у которых они также могут увеличить риск падений, эпизодов спутанности сознания и нарушения когнитивных функций [67].…”