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

Andrey V. Budnevsky, Nadezhda V. Rezova, Svetlana A. Kozhevnikova, Nikolai O. Mikhailov, Evgeniy S. Ovsyannikov

International Journal of Biomedicine. 2020;10(3):231-234.
DOI: 10.21103/Article10(3)_OA6
Originally published September 10, 2020


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.

arterial hypertension • insomnia • chronotype • quality of life

1. World Health Organization: Russian Federation. Available from:
2. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies [published correction appears in Lancet. 2003 Mar 22;361(9362):1060]. Lancet. 2002;360(9349):1903-1913. doi:10.1016/s0140-6736(02)11911-8
3. Shiryaev OY, Yankovskaya VL, Budnevsky AV, Ovsyannikov ES, Psychosomatic aspects of congestive heart failure. International Journal of Biomedicine. 2017;7(3):248-250. doi: 10.21103/Article7(3)_ShC1
4. Budnevsky AV, Ovsyannikov ES, Rezova NV, Shkatova YS. [Melatonin and hypertension: a possible role in combination therapy]. Ter Arkh. 2017;89(12):122-126. doi:10.17116/terarkh20178912122-126. [Article in Russian].
5. Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675-700. doi:10.1111/jsr.12594
6. Chechik N, Rushkevich Yu. [Importance and methods of insomnia prevention]. Nauka I Innovacii. 2017;12(178):18-21. [Article in Russian].
7. Tsvetikova LN, Budnevsky AV, Ovsyannikov ES, Kudashova EA [Melatonin: Possibilities for use in the treatment of asthma]. Ter Arkh. 2017;89(3):112-115.[Article in Russian].
8. Tsvetikova LN, Goncharenko OV, Budnevsky AV, Ovsyannikov ES, Belov VN, Kudashova EA, et al. Melatonin in treatment of sleep disorders in elderly patients with chronic obstructive pulmonary disease. International Journal of Biomedicine. 2017;7(2):108-110.
9. Nesterova MV. [Melatonin is an adaptogen with multimodal capabilities]. Meditsinskiy Sovet. 2015;(18):50-53. [Article in Russian].
10. Huang L, Zhang C, Hou Y, Laudon M, She M, Yang S, et al. Blood pressure reducing effects of piromelatine and melatonin in spontaneously hypertensive rats. Eur Rev Med Pharmacol Sci. 2013;17(18):2449-2456.
11. Levandovski R, Sasso E, Hidalgo MP. Chronotype: a review of the advances, limits and applicability of the main instruments used in the literature to assess human phenotype. Trends Psychiatry Psychother. 2013;35(1):3-11. doi:10.1590/s2237-60892013000100002
12. Roenneberg T, Kuehnle T, Pramstaller PP, Ricken J, Havel M, Miriam H, et al. A marker for the end of adolescence. Curr Biol. 2004;14(24):R1038-R1039. doi:10.1016/j.cub.2004.11.039
13. Glutkin SV, Chernysheva YuN, Zinchuk VV, Balbatun OA, Orekhov SD. [Physiological characteristics of persons with different chronotypes]. Vestnik of the Smolensk State Medical Academy.2017;16(2).[Article in Russian].
14. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension [published correction appears in Eur Heart J. 2019 Feb 1;40(5):475]. Eur Heart J. 2018;39(33):3021-3104. doi:10.1093/eurheartj/ehy339
15. Kobalava ZD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI, et al. [Arterial hypertension in adults. Clinical guidelines 2020]. Russian Journal of Cardiology. 2020;25(3):3786. [In Russian].
16. American Academy of Sleep Medicine . The international classification of sleep disorders: diagnostic and coding manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005.
17. Horne JA, Ostberg O. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol. 1976;4(2):97-110.

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Received June 18, 2020.
Accepted July 13, 2020.
©2020 International Medical Research and Development Corporation.