Effect of traditional Chinese medicine on sleep and blood pressure in patients with comorbid hypertension-insomnia: a systematic review and meta-analysis

Introduction Hypertension and insomnia frequently occur together and share neurophysiological and vascular regulatory disturbances, which increase the risk of cardiovascular disease. Traditional Chinese Medicine (TCM) uses syndrome differentiation to guide the therapeutic selection for sleep disturbance and blood pressure regulation. This study evaluated whether syndrome-informed TCM improves the sleep quality and blood pressure in adults with comorbid hypertension and insomnia. Methods We systematically searched databases including PubMed/MEDLINE, EMBASE, and Scopus from 2013 to 2025. Randomized controlled trials (RCTs) with syndrome-classified TCM interventions that reported sleep or blood pressure outcomes were eligible for the review. The sleep outcomes measured with the Pittsburgh Sleep Quality Index or Insomnia Severity Index were pooled as standardized mean differences, while systolic and diastolic blood pressure measures were synthesized separately. Results From 940 screened records, 16 studies met the inclusion criteria, and 12 trials provided data suitable for the quantitative synthesis. Quantitative synthesis showed a significant improvement in sleep quality with syndrome-informed TCM (SMD −2.21, 95% CI −3.26 to −1.16). Blood pressure reduction was smaller but statistically significant (SMD −0.43, 95% CI −0.64 to −0.21), with systolic reductions ranging from 2.5 to 6.2 mmHg in hypertensive cohorts. Conclusion The RCT analysis showed greater sleep improvement with TCM in patients with defined syndrome eligibility, with mild adverse events and outcome variation related to syndrome criteria, intervention modality, and treatment duration. Hence, the findings indicate a marked improvement in sleep and a reduction in blood pressure with syndrome-informed TCM. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261468564.