Prognostic role of melatonin in assessment of clinical course of arterial hypertension
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, no respective reduction of BP is noted during sleep. Aim. Analyze the quality of sleep, chronotypes, clinical, instrumental and laboratory parameters depending on urinary melatonin level (UML), to determine a prognosis for the course of AH in patients with insomnia. Materials and Methods. We examined 178 patients with AH and insomnia aged from 30 to 70 years (mean age 61.3±0.92 years). The AH diagnosis was based on 2018 ESC/ESH guidelines for the management of AH, and on Clinical guidelines of Russian Society of Cardiology - AH in adults (2020). The diagnosis of insomnia was based on the international classification of sleep disorders (2005). Using Multiple Regression Analysis, we determined the factors that influence the levels of systolic BP (SBP) and diastolic BP (DBP) in AH patients with insomnia. Results. Patients with AH and insomnia have a more severe clinical course of the disease, with frequent turning 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 the degree of hypertension, chronotypes, high systolic and diastolic BP, BMI, high depression and anxiety level, and low level of the quality of life in the physical and psychological aspects. Conclusion. The developed methods for calculating the levels of SBP and DBP, depending on the level of UML, body mass index, anxiety and depression level, and PSQI, allow reliable evaluation and control of the BP level in patients with AH and insomnia.