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Ethics code: IR.IAU.KHSH.REC.1403.019
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Sobhani A, Ghazanfari harandi M. The Effectiveness of Cognitive Behavioral Therapy on Blood Pressure and Sleep Quality in Patients with Hypertension. TB 2026; 24 (4) :53-68
URL: http://tbj.ssu.ac.ir/article-1-3813-en.html
URL: http://tbj.ssu.ac.ir/article-1-3813-en.html
Department of Medicine, Na.C., Islamic Azad University, Najafabad, Iran , ahmadsobhani48@iau.ac.ir
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The Effectiveness of Cognitive Behavioral Therapy on Blood Pressure and Sleep Quality in Patients with Hypertension
Marjan Ghazanfari Harandi (M.A.)1 , Ahmad Sobhani (Ph.D.)2
1.Master of Clinical Psychology, Department of Medicine, Na.C., Islamic Azad University, Najafabad, Iran
2.Corresponding Aouther: Assistant Professor of Internal Medicine, Department of Medicine, Na.C., Islamic Azad University, Najafabad, Iran E-mail:ahmadsobhani48@iau.ac.ir Tel: 09133041704
Abstract
Introduction: Hypertension is one of the major global health challenges that imposes a great burden on individuals and society. Few studies have investigated the effect of cognitive behavioral therapy on blood pressure and sleep quality, and none have been conducted simultaneously. Therefore, the present study aimed to determine the effectiveness of cognitive behavioral therapy on blood pressure and sleep quality in patients with hypertension.
Methods: The present study was a quasi-experimental study with a pretest-posttest design, control group and follow-up. The study population included patients with hypertension referred to Shariati Hospital in Isfahan. According to the inclusion criteria, 34 people were selected through purposive sampling and randomly assigned to two experimental and control groups. The instruments included a demographic questionnaire, a Pittsburgh quality questionnaire and a suitable blood pressure monitor. Cognitive behavioral therapy was performed in 8,90-minute sessions over a month for the intervention group. Data were analyzed using analysis of covariance and Bonferroni post hoc test and SPSS software version 27.
Results: Cognitive behavioral therapy was effective in reducing diastolic and systolic blood pressure and increasing sleep quality (F=439/292, P<0/05) in patients with hypertension, and the results were generally stable at follow-up (F=237/053, P<0/05).
Conclusion: The results of the present study show that cognitive behavioral therapy can be associated with reducing blood pressure and improving sleep quality. Low-cost cognitive behavioral therapy can be used alongside drug therapy to improve the health of patients with hypertension.
Keywords: Cognitive Behavioral Therapy, Blood Pressure, Sleep Quality, Hypertension
Conflict of interest: The authors declared no conflict of interest.
1-Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-237.
2-Teza H, Boonmanunt S, Unwanatham N & et al. Evaluation of transitions from early hypertension to hypertensive chronic kidney disease, coronary artery disease, stroke and mortality: a Thai real-world data cohort. Frontiers in Cardiovascular Medicine. 2023; 2;10:1170010.
3-World Health Organization. Hypertension fact sheet[Internet]. 2023 [cited 2025 Dec 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
4-World Health Organization. Hypertension Country Profile: Islamic Republic of Iran [Internet]. 2023 [cited 2025 Dec 26] Available from: https://cdn.who.int/media/docs/default-source/country profiles/hypertension/hypertension_irn_2023.pdf
5-Mohammadi S, Hassanipour S, Delam H & et al. Prevalence of hypertension in Iran: An updated systematic review and meta-analysis of community-based studies. Caspian J Intern Med. 2023;14(4):607-617.[Persian]
6-Lv Y, Jiang G, Tan X & et al. Association of Sleep Patterns and Lifestyles With Incident Hypertension: Evidence From a Large Population-Based Cohort Study. Front Cardiovasc Med. 2022;1;9:847452.
7-Liu PY. Rhythms in cortisol mediate sleep and circadian impacts on health. Sleep. 2024; 9;47(9):1-3.
8-Boustani Mavi Gh, Akbari B, Kiamarsi A. The effectiveness of positive psychotherapy on systolic and diastolic blood pressure and psychological well-being of women with hypertension: a quasi-experimental study. Journal of Rafsanjan University of Medical Sciences. 2023; 22 (9): 999-1014.[Persian]
9-Khazaie H, Jalali A, Khazaie A & et al. The prevalence of sleep disorders in Iranian adults - an epidemiological study. BMC Public Health. 2024;12;24(1):3141. [Persian]
10-Mottaghi R, Maredpour A, Karamin S. A Comparison Study on the Effectiveness of Acceptance and Commitment Therapy and Sleep Hygiene Education on Sleep Quality and Physiological Parameters in Older Adults. Salmand: Iranian Journal of Ageing 2022; 17 (2) :170-185.[Persian]
11-Yang Z, Heizhati M, Wang L & et al. Subjective poor sleep quality is associated with higher blood pressure and prevalent hypertension in general population independent of sleep disordered breathing. Nature and Science of Sleep. 2021;8:1759-1770.
12-Scott H, Lechat B, Guyett A & et al. Sleep Irregularity Is Associated With Hypertension: Findings From Over 2 Million Nights With a Large Global Population Sample. Hypertension. 2023;80(5):1117-1126.
13-Jones DW, Ferdinand KC, Taler SJ & et al. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025;86(18):1679.
14-Riemann D,Dressle RJ,Spiegelhalder K.Insomnia Guidelines—The European Update 2023. Clinical and Translational Neuroscience.2024;8(1):10.
15-Li R, Rueschman M, Gottlieb DJ & et al. A composite sleep and pulmonary phenotype predicting hypertension. EbioMedicine. 2021;1;68:103433.
16-Arezomand M, Dehghan M, Rigi ZE & et al. The effect of using a sports application on the quality of sleep in patients with heart failure: a randomized clinical trial study. BMC Sports Sci Med Rehabil. 2024;16(1):15.[Persian]
17-Sherwood A, Ulmer C, Wu JQ & et al. Cognitive behavior therapy for insomnia for untreated hypertension with comorbid insomnia disorder: The Sleepright clinical trial. J Clin Hypertens (Greenwich). 2024;26(4):441-447.
18-Sweetman A, Farrell S, Wallace DM & et al. The effect of cognitive behavioural therapy for insomnia in people with comorbid insomnia and sleep apnoea: A systematic review and meta-analysis. Journal of Sleep Research. 2023;32(6):e13847.
19-Asefmehr S, Bahramian A, Shahabizade F. The effect of the cognitive behavioral group therapy based on mindful walking with the dialectical behavior therapy on psychological symptoms, quality of life and blood pressure on people with hypertention. Iranian Journal of Cardiovascular Nursing. 2022;11 (1): 130-138.[Persian]
20-Hansford HJ, Parmenter BJ, McLeod KA & et al.The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis. Hypertension Research. 2021;44(11):1373-1384.
21-Sirwan Khalid Ahmed,How to choose a sampling technique and determine sample size for research: A simplified guide for researchers,Oral Oncology Reports, 2024;12,ISSN 2772-9060.
22-Matteo Carpi, The Pittsburgh Sleep Quality Index: a brief review, Occupational Medicine, 2025;75(1):14-15.
23-Chehri A, Nourozi M, Eskandari S & et al. Validation of the Persian version of the Pittsburgh Sleep Quality Index in elderly population. Sleep Sci. 2020;13(2):119-124.
24-Shadzi MR, Rahmanian M, Heydari A & et al. Structural validity of the Pittsburgh Sleep Quality Index among medical students in Iran. Sci Rep. 2024;14(1):1538.
25-Mancia G, Kreutz R, Brunström M & et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the EuropeanRenalAssociation(ERA). JHypertens.2023;41(12):1874-2071.
26-Muntner P, Shimbo D, Carey RM & et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension.2019;73(5): 35-66.
27-Moezi Bady SA, Kazemi T, Mashreghi-Moghadam H & et al. A comprehensive overview of the diagnosis and treatment of hypertension based on the latest hypertension guidelines. Journals of Birjand University of Medical Sciences 2021; 28 (3) :194-221.[Persian]
28-Murphy JL, Cordova MJ, Dedert EA. Cognitive behavioral therapy for chronic pain in veterans: Evidence for clinical effectiveness in a model program. Psychol Serv. 2022;19(1):95-102.
29-Li Y, Buys N, Li Z & et al. The efficacy of cognitive behavioral therapy-based interventions on patients with hypertension: A systematic review and meta-analysis. Preventive medicine reports. 2021;1;23:101477.
30-Mason EC, Grierson AB, Sie A & et al. Co- occurring insomnia and anxiety: a randomized controlled trial of internet cognitive behavioral therapy for insomnia versus internet cognitive behavioral therapy for anxiety. Sleep. 2023;1;46(2):1-15.
31-Morin CM, Buysse DJ. Management of Insomnia. N Engl J Med. 2024;391(3):247-258.
Marjan Ghazanfari Harandi (M.A.)1 , Ahmad Sobhani (Ph.D.)2
1.Master of Clinical Psychology, Department of Medicine, Na.C., Islamic Azad University, Najafabad, Iran
2.Corresponding Aouther: Assistant Professor of Internal Medicine, Department of Medicine, Na.C., Islamic Azad University, Najafabad, Iran E-mail:ahmadsobhani48@iau.ac.ir Tel: 09133041704
Abstract
Introduction: Hypertension is one of the major global health challenges that imposes a great burden on individuals and society. Few studies have investigated the effect of cognitive behavioral therapy on blood pressure and sleep quality, and none have been conducted simultaneously. Therefore, the present study aimed to determine the effectiveness of cognitive behavioral therapy on blood pressure and sleep quality in patients with hypertension.
Methods: The present study was a quasi-experimental study with a pretest-posttest design, control group and follow-up. The study population included patients with hypertension referred to Shariati Hospital in Isfahan. According to the inclusion criteria, 34 people were selected through purposive sampling and randomly assigned to two experimental and control groups. The instruments included a demographic questionnaire, a Pittsburgh quality questionnaire and a suitable blood pressure monitor. Cognitive behavioral therapy was performed in 8,90-minute sessions over a month for the intervention group. Data were analyzed using analysis of covariance and Bonferroni post hoc test and SPSS software version 27.
Results: Cognitive behavioral therapy was effective in reducing diastolic and systolic blood pressure and increasing sleep quality (F=439/292, P<0/05) in patients with hypertension, and the results were generally stable at follow-up (F=237/053, P<0/05).
Conclusion: The results of the present study show that cognitive behavioral therapy can be associated with reducing blood pressure and improving sleep quality. Low-cost cognitive behavioral therapy can be used alongside drug therapy to improve the health of patients with hypertension.
Keywords: Cognitive Behavioral Therapy, Blood Pressure, Sleep Quality, Hypertension
Conflict of interest: The authors declared no conflict of interest.
1-Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-237.
2-Teza H, Boonmanunt S, Unwanatham N & et al. Evaluation of transitions from early hypertension to hypertensive chronic kidney disease, coronary artery disease, stroke and mortality: a Thai real-world data cohort. Frontiers in Cardiovascular Medicine. 2023; 2;10:1170010.
3-World Health Organization. Hypertension fact sheet[Internet]. 2023 [cited 2025 Dec 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
4-World Health Organization. Hypertension Country Profile: Islamic Republic of Iran [Internet]. 2023 [cited 2025 Dec 26] Available from: https://cdn.who.int/media/docs/default-source/country profiles/hypertension/hypertension_irn_2023.pdf
5-Mohammadi S, Hassanipour S, Delam H & et al. Prevalence of hypertension in Iran: An updated systematic review and meta-analysis of community-based studies. Caspian J Intern Med. 2023;14(4):607-617.[Persian]
6-Lv Y, Jiang G, Tan X & et al. Association of Sleep Patterns and Lifestyles With Incident Hypertension: Evidence From a Large Population-Based Cohort Study. Front Cardiovasc Med. 2022;1;9:847452.
7-Liu PY. Rhythms in cortisol mediate sleep and circadian impacts on health. Sleep. 2024; 9;47(9):1-3.
8-Boustani Mavi Gh, Akbari B, Kiamarsi A. The effectiveness of positive psychotherapy on systolic and diastolic blood pressure and psychological well-being of women with hypertension: a quasi-experimental study. Journal of Rafsanjan University of Medical Sciences. 2023; 22 (9): 999-1014.[Persian]
9-Khazaie H, Jalali A, Khazaie A & et al. The prevalence of sleep disorders in Iranian adults - an epidemiological study. BMC Public Health. 2024;12;24(1):3141. [Persian]
10-Mottaghi R, Maredpour A, Karamin S. A Comparison Study on the Effectiveness of Acceptance and Commitment Therapy and Sleep Hygiene Education on Sleep Quality and Physiological Parameters in Older Adults. Salmand: Iranian Journal of Ageing 2022; 17 (2) :170-185.[Persian]
11-Yang Z, Heizhati M, Wang L & et al. Subjective poor sleep quality is associated with higher blood pressure and prevalent hypertension in general population independent of sleep disordered breathing. Nature and Science of Sleep. 2021;8:1759-1770.
12-Scott H, Lechat B, Guyett A & et al. Sleep Irregularity Is Associated With Hypertension: Findings From Over 2 Million Nights With a Large Global Population Sample. Hypertension. 2023;80(5):1117-1126.
13-Jones DW, Ferdinand KC, Taler SJ & et al. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025;86(18):1679.
14-Riemann D,Dressle RJ,Spiegelhalder K.Insomnia Guidelines—The European Update 2023. Clinical and Translational Neuroscience.2024;8(1):10.
15-Li R, Rueschman M, Gottlieb DJ & et al. A composite sleep and pulmonary phenotype predicting hypertension. EbioMedicine. 2021;1;68:103433.
16-Arezomand M, Dehghan M, Rigi ZE & et al. The effect of using a sports application on the quality of sleep in patients with heart failure: a randomized clinical trial study. BMC Sports Sci Med Rehabil. 2024;16(1):15.[Persian]
17-Sherwood A, Ulmer C, Wu JQ & et al. Cognitive behavior therapy for insomnia for untreated hypertension with comorbid insomnia disorder: The Sleepright clinical trial. J Clin Hypertens (Greenwich). 2024;26(4):441-447.
18-Sweetman A, Farrell S, Wallace DM & et al. The effect of cognitive behavioural therapy for insomnia in people with comorbid insomnia and sleep apnoea: A systematic review and meta-analysis. Journal of Sleep Research. 2023;32(6):e13847.
19-Asefmehr S, Bahramian A, Shahabizade F. The effect of the cognitive behavioral group therapy based on mindful walking with the dialectical behavior therapy on psychological symptoms, quality of life and blood pressure on people with hypertention. Iranian Journal of Cardiovascular Nursing. 2022;11 (1): 130-138.[Persian]
20-Hansford HJ, Parmenter BJ, McLeod KA & et al.The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis. Hypertension Research. 2021;44(11):1373-1384.
21-Sirwan Khalid Ahmed,How to choose a sampling technique and determine sample size for research: A simplified guide for researchers,Oral Oncology Reports, 2024;12,ISSN 2772-9060.
22-Matteo Carpi, The Pittsburgh Sleep Quality Index: a brief review, Occupational Medicine, 2025;75(1):14-15.
23-Chehri A, Nourozi M, Eskandari S & et al. Validation of the Persian version of the Pittsburgh Sleep Quality Index in elderly population. Sleep Sci. 2020;13(2):119-124.
24-Shadzi MR, Rahmanian M, Heydari A & et al. Structural validity of the Pittsburgh Sleep Quality Index among medical students in Iran. Sci Rep. 2024;14(1):1538.
25-Mancia G, Kreutz R, Brunström M & et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the EuropeanRenalAssociation(ERA). JHypertens.2023;41(12):1874-2071.
26-Muntner P, Shimbo D, Carey RM & et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension.2019;73(5): 35-66.
27-Moezi Bady SA, Kazemi T, Mashreghi-Moghadam H & et al. A comprehensive overview of the diagnosis and treatment of hypertension based on the latest hypertension guidelines. Journals of Birjand University of Medical Sciences 2021; 28 (3) :194-221.[Persian]
28-Murphy JL, Cordova MJ, Dedert EA. Cognitive behavioral therapy for chronic pain in veterans: Evidence for clinical effectiveness in a model program. Psychol Serv. 2022;19(1):95-102.
29-Li Y, Buys N, Li Z & et al. The efficacy of cognitive behavioral therapy-based interventions on patients with hypertension: A systematic review and meta-analysis. Preventive medicine reports. 2021;1;23:101477.
30-Mason EC, Grierson AB, Sie A & et al. Co- occurring insomnia and anxiety: a randomized controlled trial of internet cognitive behavioral therapy for insomnia versus internet cognitive behavioral therapy for anxiety. Sleep. 2023;1;46(2):1-15.
31-Morin CM, Buysse DJ. Management of Insomnia. N Engl J Med. 2024;391(3):247-258.
Type of Study: Research |
Subject:
Psychology
Received: 2025/06/18 | Accepted: 2025/09/13 | Published: 2026/03/1
Received: 2025/06/18 | Accepted: 2025/09/13 | Published: 2026/03/1
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