Controlling Hypertension Together: the case for the missing eight hours

Every year on 17 May, the global hypertension community marks World Hypertension Day. The 2026 theme, “Controlling Hypertension Together,” is set by the World Hypertension League, the international body that brings together 85 national hypertension societies to drive prevention, detection and control of high blood pressure^[1]. It is a theme of shared responsibility, and one with direct relevance for Sleep Health Europe.

The League’s current president, Prof. Gianfranco Parati, also serves on Sleep Health Europe’s editorial board. At the coalition’s launch in Brussels this March, he set out a clinical case that European hypertension policy is increasingly having to confront: blood pressure does not stop changing when the clinic closes, and what happens overnight is as relevant to cardiovascular risk as what happens during the consultation.

Hypertension is often described as the silent killer. The phrase has earned its place. An estimated 1.4 billion people live with hypertension globally, and only around one in four has it adequately controlled^[2]. But the silence is not only metaphorical. Across most of Europe, blood pressure is measured during the day, in clinics or at home, in the hours when patients are awake. The remaining third of life, the hours spent asleep, sits largely outside the screening picture. That is a problem, because it is precisely when sleep is disrupted that blood pressure can rise most dangerously, and most invisibly.

The clinical case is no longer disputed. European hypertension guidelines now recognise sleep-disordered breathing as a contributing factor in hypertension and cardiovascular risk^[3]. Studies have consistently reported obstructive sleep apnoea in 70 to 80 percent of patients with resistant hypertension, the form of hypertension that does not respond to three or more medications^[4]. In 2025, the European Society of Hypertension published a dedicated position paper on nocturnal blood pressure, led by Prof. Parati, which identifies the treatment of sleep-related breathing disorders as one of the few interventions shown to lower blood pressure during sleep^[5]. In 2022, the American Heart Association revised its long-standing “Life’s Simple 7” framework into “Life’s Essential 8” by adding sleep alongside blood pressure, cholesterol, glucose, weight, diet, physical activity and tobacco avoidance^[6]. The cardiovascular community has, in other words, already moved.

The European policy framework is moving in the same direction. The European Commission’s Safe Hearts Plan, the EU’s first dedicated cardiovascular strategy, builds its prevention pillar around an EU Protocol on Health Checks with a “know your numbers” approach for hypertension, obesity and diabetes. Its flagship “EU Cares for Your Heart” initiative asks Member States to develop or implement national cardiovascular health plans by 2027^[7]. The ambition is real and welcome.

The next step is to ensure that the numbers Europe asks its citizens to know include the ones that change while they are asleep.

This is not an argument against any of the existing pillars of cardiovascular prevention. It is an argument for completeness. A patient whose daytime blood pressure looks reassuring may still be a non-dipper at night, with sustained pressure that quietly damages arteries, kidneys and the heart. The 2025 ESH position paper identifies nocturnal blood pressure as one of the strongest predictors of cardiovascular events, often outperforming clinic or daytime readings^[5]. A patient with obstructive sleep apnoea may live with repeated nocturnal blood pressure surges that no clinic visit will ever capture. These patients exist in every Member State, on primary care lists, in cardiology clinics, in workplaces. They are not currently being looked for systematically. They could be.

What would that look like in practice? In policy terms, it means recognising sleep-disordered breathing as a modifiable cardiovascular risk factor within the EU Protocol on Health Checks, and supporting Member States to integrate sleep into the cardiometabolic checks the Plan envisages. In clinical terms, it means a lower threshold for ambulatory or home blood pressure monitoring in patients with poorly controlled hypertension, and a routine question about snoring, witnessed apnoeas and daytime sleepiness in cardiovascular risk consultations. Neither requires new technology. Both require recognition.

The 2026 theme of World Hypertension Day asks us to control hypertension together. That word matters. Hypertension is not controlled by cardiology alone, by primary care alone, by patients alone, or by sleep medicine alone. It is controlled when each of those communities brings its evidence to a shared table, and when European policy makes room for all of it.

Sleep Health Europe is built on that principle. The coalition brings together cardiology, neurology, primary care, respiratory, nursing, patient organisations and industry partners around a single proposition: that sleep is foundational to public health, and that European policy should treat it as such. World Hypertension Day is a moment to say it plainly. Controlling blood pressure means measuring it where it actually changes, and that includes the eight hours every night when most of Europe stops looking

Sleep is good for you. Sleep is good for EU.

References

[1] World Hypertension League. World Hypertension Day 2026: “Controlling Hypertension Together!” Available at: https://www.whleague.org/about-us/world-hypertension-day (accessed May 2026).

[2] World Health Organization. World Hypertension Day, 17 May 2026. Available at: https://www.who.int/news-room/events/detail/2026/05/17/default-calendar/world-hypertension-day-2026 (accessed May 2026).

[3] Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension. Journal of Hypertension 2023; 41(12): 1874–2071. Available at: https://doi.org/10.1097/HJH.0000000000003480.

[4] Hisamatsu T, Miura K. Obstructive sleep apnea-related hypertension: a review of the literature and clinical management strategy. Hypertension Research 2024; 47: 3085–3098. Available at: https://www.nature.com/articles/s41440-024-01852-y.

[5] Parati G, Pengo MF, Avolio A, et al; ESH Working Group on Blood Pressure Monitoring and Cardiovascular Variability. Nocturnal blood pressure: pathophysiology, measurement and clinical implications. Position paper of the European Society of Hypertension. Journal of Hypertension 2025; 43(8): 1296–1318. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12237141/.

[6] Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation 2022; 146: e18–e43. Available at: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001078.

[7] European Commission, DG SANTE. Cardiovascular health: the EU Safe Hearts Plan. Available at: https://health.ec.europa.eu/non-communicable-diseases/cardiovascular-health_en (accessed May 2026).