Effects of hypnotics on nocturnal blood pressure: a systematic review and meta-analysis of randomised controlled trials

PURPOSE: There is currently no specific treatment for nocturnal hypertension (HT). By improving sleep quality and drug-specific mechanisms, hypnotics have been suggested as a potential treatment for nocturnal HT, but this has never been investigated by a systematic review and meta-analysis. MATERIALS AND METHODS: Multiple databases were searched since inception till 19 November 2024. Only randomised controlled trials (RCTs) comparing oral hypnotics administration for ≥1 week versus placebo and reporting nocturnal systolic blood pressure (SBP) or diastolic blood pressure (DBP) were included. Study selection, data extraction and quality assessment (by the Cochrane risk-of-bias tool) were conducted by two independent reviewers. Pairwise meta-analysis using a random effect model pooled weighted mean BP difference. RESULTS: : 74.6%) and daytime/24-h/office SBP/DBP except for nonbenzodiazepine benzodiazepine receptor agonists (NBZRAs), which may reduce 24-h SBP. Benzodiazepines increase 24-h/daytime/nighttime heart rate. Seven included studies had unclear to high risk of bias. Strength of evidence was ranked very low to low. This is the first meta-analysis to investigate the effects of hypnotics on nocturnal BP, highlighting the lack of adequately powered and low-risk-of-bias studies, especially in patients with HT and insomnia, who may experience preferential nocturnal BP reduction with hypnotics, but this hypothesis is currently supported only by two RCTs involving NBZRAs. CONCLUSIONS: Despite limited data, hypnotics appear to have neutral effects on BP, including nocturnal SBP and DBP, and currently have no role in clinical practice for the treatment of HT (PROSPERO no.: CRD42023490914).