The association between sleep quality metrics and resistant hypertension progression

Resistant hypertension (RH) poses a significant cardiovascular risk, particularly in regions like Uzbekistan with rising prevalence, yet modifiable factors influencing its progression remain underexplored. Sleep quality disruptions may accelerate RH through nocturnal blood pressure surges and inflammation, but evidence from Central Asia is lacking. This study conducted from March 2024 to September 2025 at the Republican Specialized Scientific-Practical Medical Center of Cardiology in Tashkent, we followed 320 adults (mean age 58.4 years, 50.6% male) with RH. Sleep was assessed via Pittsburgh Sleep Quality Index (PSQI) and actigraphy at baseline and 6-month intervals. RH progression was defined by 24-hour ambulatory BP increase ≥10 mmHg systolic, medication escalation, or organ damage. Multivariable Cox regression evaluated associations, adjusting for age, BMI, diabetes, and smoking. Over 18 months, 92 (28.8%) progressed. Progressors had poorer baseline PSQI (10.2 ± 3.1 vs. 7.9 ± 3.2, p<0.001), sleep efficiency (72% ± 11% vs. 81% ± 10%, p<0.001), and hs-CRP (3.2 ± 1.8 mg/L vs. 2.1 ± 1.4, p=0.002). Adjusted HRs were 1.18 (95% CI 1.10-1.26) per PSQI unit and 1.32 (1.20-1.46) per 5% efficiency drop (both p<0.001; c-statistic 0.78). Kaplan-Meier analysis showed early divergence (log-rank p<0.001).The findings shows, Poor sleep quality robustly predicts RH progression in Uzbek patients, highlighting a modifiable target for intervention. Routine PSQI screening could refine management in resource-limited settings.