Abstract
BACKGROUND: The benefits and risks of sleep medications among patients with hypertension and sleep disturbance remain unclear. This study aims to investigate the potential benefits and risks of sleep medications in this population. METHODS: This was a prospective cohort study among US adults, using hypertension and medication data from the National Health and Nutrition Examination Survey (NHANES). Linear regression assessed the efficacy of sleep medications in controlling blood pressure. Cox regression explored associations between sleep medications and mortality. RESULTS: This study included 4836 participants taking antihypertensive medication with sleep disturbance. Compared with non-users, benzodiazepine users had an adjusted estimated systolic blood pressure (SBP) difference of -2.22 mmHg (95% CI, -3.70 to -0.74; P = 0.003), while benzodiazepine-like agents (Z-drugs) users had a more pronounced difference of -3.33 mmHg (95% CI, -5.85 to -0.81; P = 0.010), with diazepam, clonazepam, and zolpidem demonstrating significant antihypertensive effects. The median follow-up time was 82.3 months, and 809 all-cause deaths occurred. Sleep medications (hazard ratio [HR]: 1.14; 95% CI, 0.97 to 1.33; P = 0.120) and benzodiazepine users (HR: 1.05; 95% CI, 0.87 to 1.26; P = 0.639) were not associated with an increased risk of all-cause mortality, while Z-drug users were linked to a higher risk (HR: 1.39; 95% CI, 1.04 to 1.85; P = 0.025) compared to non-users. No significant association was found with cardiovascular mortality. CONCLUSIONS: Sleep medication use is associated with lower blood pressure and is not significantly associated with an elevated mortality risk among hypertensive participants with sleep disturbance.