Sleep and Hypertension

Abstract

The article by Gangwisch et al1 in this issue of Hypertension identifies another significant health hazard associated with inadequate sleep. The authors document ≈2-fold greater risk for hypertension among adults in their fourth to sixth decades who sleep ≤5 hours each night. Whereas the independent risk of short sleep duration for developing hypertension is attenuated to ≈1.6-fold after adjusting for obesity and diabetes, short sleep duration is a risk factor for obesity and diabetes.2,3 The investigators provide plausible mechanisms linking short sleep duration to hypertension.1 Potential mechanisms include an increased blood pressure (BP) load resulting from prolongation of higher BP while awake and truncation of the BP dip characteristic of sleep. A decrease in sleep duration leads to both greater BP load1 and prolonged exposure to an activated sympathetic nervous system,4 which could accentuate structural remodeling and augment renal sodium retention. Structural changes in key target organs participating in BP regulation including the kidney, heart, and vasculature could serve to perpetuate and accelerate age-related increases in BP, especially in those at risk. In this regard, it is interesting to note a study of rapid eye movement sleep deprivation in spontaneously hypertensive, normotensive Wistar-Kyoto, and borderline hypertensive …