Lorenzo Ghiadoni

Relationship between insomnia symptoms, perceived stress and coping strategies in subjects with arterial hypertension: psychological factors may play a modulating role

OBJECTIVE The aim of the study was to evaluate perceived stress and coping strategies in people with hypertension, according to the presence of insomnia symptoms and by using a set of variables that included anxiety and depressive symptoms evaluation. METHODS A total of 371 hypertensive patients were enrolled during their first visit to the Hypertension Outpatient Unit. The Perceived Stress Scale (PSS), Brief-COPE, Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Self-rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI) were administered. Patients with other sleep disorders or with incomplete data (n = 41) were excluded. RESULTS Data from 330 hypertensive patients were analyzed (males 51%, mean age 57 ± 13 years). Those with insomnia symptoms (n = 70, 21%) were older (p = 0.02), more frequently females (p = 0.01), and presented with higher PSS (p < 0.001), BDI (p < 0.0001), SAS (p = 0.0003), and STAI (p < 0.0001) scores than those without insomnia symptoms. In a linear regression trait, anxiety (p < 0.0001) and depressive symptoms (p < 0.05) were independent predictors of high PSS. Patients with insomnia symptoms showed lower scores in coping strategies, such as positive reframing (p = 0.03) and emotional support (p = 0.04), and an increased score in behavioral disengagement (p = 0.03). Trait anxiety and insomnia severity were independent predictors of less effective coping strategies. CONCLUSIONS People with hypertension and insomnia symptoms showed higher perceived stress and less effective coping strategies than non-insomniacs; psychological factors such as trait anxiety and depressive symptoms may play a modulating role in these relationships. Prevention and treatment of insomnia symptoms and psychological factors should receive high attention for people with hypertension.

Estrogen and Endothelial Function

Although observational studies have shown that estrogen can protect women against cardiovascular diseases (CVD), the underlying mechanisms are not fully clarified. Endothelium plays a pivotal role in the control of vascular function and structure; endothelial dysfunction, characterized by reduced or absent nitric oxide (NO) bioavailability linked and/or due to the production of cyclooxygenase-dependent endothelial-derived contracting factors (EDCFs), mainly represented by oxygen free radicals, is now viewed as an important mechanism causing atherothrombosis. Data in humans indicate that endogenous estrogen plays a protective role on endothelial function. Thus premenopausal women are protected against the adverse effect of hypercholesterolemia, with age-related impairment of endothelial function occurring only after the menopause in normotensive women and mainly after the menopause in hypertensive women. Moreover endogenous estrogen deprivation selectively impairs endothelial function in normotensive women. There is also evidence that exogenous estrogen can improve endothelial function in postmenopausal women. Thus acute intraarterial or intravenous infusion of estrogen potentiates endothelium-dependent vasodilation both in coronary circulation and the forearm. Estrogen replacement therapy (ERT) seems to improve endothelial function both in coronary arteries of postmenopausal women with coronary atherosclerosis and in brachial arteries of postmenopausal women with mild hypercholesterolemia. Although short-term ERT did not improve endothelial function in the forearm of perimenopausal women and in postmenopausal women with various cardiovascular risk factors, 3-month ERT restored endothelial function in ovariectomized women.