Insomnia and Hypertension in African Ancestry Women: Epidemiology, Mechanisms, and Public Health Implications

Abstract

Insomnia and hypertension each represent major global health burdens, and their co-occurrence in women of African ancestry has emerged as a clinically and epidemiologically distinct phenomenon warranting urgent scientific scrutiny. Women of African ancestry — encompassing populations across sub-Saharan Africa, the Caribbean, the Americas, and other regions of the African diaspora — experience disproportionately high rates of both insomnia and hypertension relative to women of other racial and ethnic backgrounds. The convergence of these conditions is not merely coincidental; accumulating evidence suggests a bidirectional, mechanistically complex relationship mediated by dysregulation of the autonomic nervous system, the hypothalamic–pituitary–adrenal axis, pro-inflammatory pathways, and the renin–angiotensin–aldosterone system. Structural inequities, including chronic exposure to racial discrimination, socioeconomic disadvantage, neighbourhood deprivation, and the cumulative physiological toll of chronic psychosocial stress — encapsulated in the concept of allostatic load — further compound biological vulnerability in this population. Despite this, women of African ancestry have been systematically underrepresented in sleep research and in hypertension trials, limiting the generalisability of existing evidence and perpetuating health disparities. This review synthesizes current epidemiological, mechanistic, and public health literature to characterize the insomnia–hypertension relationship in women of African ancestry, identify persistent gaps in knowledge, and propose culturally sensitive directions for future research and policy. The findings argue for the integration of systematic sleep health assessment into hypertension management pathways, for investment in culturally adapted and community-anchored sleep interventions, and for the dismantling of structural barriers to care that disproportionately disadvantage women of African ancestry.