Sleep and Hypertension Burning the Candle at Both Ends Really Is Hazardous to Your Health

The article by Gangwisch et al1 in this issue of Hyperten-sion identifies another significant health hazard asso-ciated 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 devel-oping hypertension is attenuated to1.6-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 accen-tuate structural remodeling and augment renal sodium reten