Assessment of sleep quality and perceived stress in hypertension patients

Introduction and Aim: Hypertension is one of the leading causes of cardiovascular morbidity and mortality and is a condition associated with impaired sleep quality and increased levels of perceived stress. Disruption of sleep patterns together with an increased stress load may make blood pressure control more difficult and adversely affect quality of life. This study aimed to evaluate sleep quality and perceived stress levels in adult patients with hypertension admitted to the Family Medicine Outpatient Clinic of Ankara Bilkent City Hospital, to demonstrate the relationship between these two variables and to examine this relationship in the context of sociodemographic and clinical characteristics. Materials and Methods: This cross-sectional, questionnaire-based study was conducted between 01.09.2025 and 01.12.2025 with 250 volunteer individuals aged 18 years and older who had a diagnosis of hypertension and were admitted to the family medicine outpatient clinics of Ankara Bilkent City Hospital. Sociodemographic characteristics and information related to disease and lifestyle were collected using a structured questionnaire form. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and perceived stress level was evaluated with the 14-item Perceived Stress Scale (PSS-14). The data were analyzed using descriptive statistical methods, appropriate parametric and non-parametric comparison tests and correlation analyses, and additionally a generalized linear model was constructed in which the PSQI total score was defined as the dependent variable. Results: The mean age of the participants was 61.44±11.36 years; 48.8% were women and 51.2% were men. The mean PSQI total score was 6.79±3.74, and 59.6% of the individuals were classified as having poor sleep quality due to a PSQI score > 5. PSS-14 scores were most frequently observed in the 25–33 point range. There was a weak but statistically significant positive association between PSQI score and both age and duration of hypertension, and a significant negative association between PSQI score and daily sleep duration. A moderate, positive and statistically significant correlation was found between PSQI total score and PSS-14 total score (r = 0.498; p < 0.001), and in the generalized linear model each 1-point increase in PSS-14 score was associated with approximately a 0.20-point increase in PSQI total score. PSS-14 scores were higher among widowed/divorced participants, those who were not employed, those whose income was lower than their expenses, individuals with more than one chronic disease and those who did not engage in regular physical activity; statistically significant but weak associations were also identified between daily coffee and water consumption and PSS-14 scores. Conclusion and Recommendations: In hypertensive patients presenting to a primary care family medicine outpatient clinic, poor sleep quality was found to be common, and mean PSS-14 scores clustered around the mid-range of the scale, indicating a considerable perceived stress burden in this patient group. The independent and significant association between sleep quality and perceived stress highlights the importance of routinely assessing both sleep problems and stress levels during hypertension follow-up. Holistic interventions including sleep hygiene counselling, stress management strategies, regular physical activity and healthy lifestyle modifications may improve both sleep quality and perceived stress in patients with hypertension, thereby contributing positively to blood pressure control and quality of life. These findings are expected to guide the planning of screening and intervention programs for hypertension management in primary care and should be supported by multicenter, prospective studies conducted in different regions. Keywords: Hypertension, Sleep quality, Pittsburgh Sleep Quality Index, Perceived Stress Scale, Primary care, Family medicine