Pathogenesis and therapeutic potential of traditional Chinese medicine intervention in hypertension combined with insomnia.

Hypertension comorbid with insomnia (HTN-Ins) is a common clinical comorbidity. Symptoms associated with HTN-Ins correspond to the TCM disease categories of xuanyun (dizziness), xinji (palpitations), and bumei (insomnia). Traditional Chinese medicine (TCM) exerts unique therapeutic advantages against HTN-Ins via regulating the body's dynamic imbalance. This review aims to summarize the characteristics of TCM for treating HTN-Ins, including single Chinese herbs, Chinese medicine monomers, compound TCM prescriptions, TCM patented drugs, and other TCM-related therapeutic approaches, focusing on the analysis of the relevant mechanisms of TCM treatment of this disease. Using the search terms "traditional Chinese medicine", "hypertension and insomnia", "hypertension combined with insomnia", "hypertension", "insomnia", "sleep disorder", "mechanism", "clinical observation", "randomized controlled trial", we searched PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) for studies published in the past five years up to April 2026. From the literature review, we found that Chinese herbs such as Gastrodia elata Blume., Uncaria rhynchophylla (Miq.) Miq., Conioselinum anthriscoides 'Chuanxiong'., Salvia miltiorrhiza Bunge and Astragalus mongholicus Bunge were commonly used for the treatment of HTN-Ins. Traditional Chinese medicine monomers such as quercetin, kaempferol, luteolin|, baicalein are beneficial for the treatment of HTN-Ins. A large number of traditional Chinese medicine compounds have significant effects, including Tianma-Gouteng decoction, Huanglian-Wendan decoction, Guizhilonggu-oyster decoction, etc. In recent years, traditional Chinese patent medicine has been used in the treatment of HTN-Ins, such as Guanxin Ning tablets, compound pearl Tiaozhi capsules, Qishen Yiqi dropping pills, Shuhe granules, and so on. Research has also shown that TCM works in a variety of ways, including the inhibiting excessive activation of the sympathetic nervous system, reducing the levels of relevant inflammatory factors, alleviating oxidative stress, regulating the renin-angiotensin-aldosterone system (RAAS), regulating the hypothalamic-pituitary-adrenal (HPA) axis, and regulating neurotransmitter levels. These actions collectively produce comprehensive pharmacological effects, such as sedative-hypnotic activity, stable blood pressure reduction, and vascular protection. TCM exhibits remarkable therapeutic efficacy in the treatment of HTN-Ins through multi-target, multi-pathway, multi-level, and individualized strategies, thereby demonstrating substantial therapeutic potential. However, limitations remain. In the future, in-depth exploration of the pharmacological mechanisms underlying individual TCM monomers and large-sample, multi-center randomized controlled clinical trials (RCTs) of TCM compound prescriptions will be the primary research directions in this field.