Sleep Deprivation Linked to Hypertension

Gangwisch JE, Heymsfield SB, Boden-Albala B, et al. Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension. 2006 May;47(5):833-839.

Short sleep durations over a prolonged period appear to be an important and potentially modifiable risk factor for hypertension. Previous reports have linked sleep disorders with cardiovascular disease, but it was unclear if sleep deprivation in subjects who did not have a sleep disorder affected the risk of hypertension. The findings are based on an analysis of data for 4,810 subjects between 32 and 86 years of age, who participated in the first National Health and Nutrition Examination Survey. Hypertension was diagnosed in 647 subjects during the follow-up period from 1982 to 1992. Among the subjects between 32 and 59 years of age, sleeping less than 6 hours per night raised the risk of hypertension by 2.10-fold. This association remained significant after adjusting for obesity and diabetes, which were both hypothesized to be partial mediators of the relationship. Further studies are needed to better understand the mechanisms linking sleep deprivation with high blood pressure.

Heart Drugs Improve Survival of PAD Patients

Feringa HH, van Waning VH, Bax JJ, et al. Cardioprotective medication is associated with improved survival in patients with peripheral arterial disease. J Am Coll Cardiol. 2006 Mar. 21; 47(6):1182-1187.

Drugs used to treat heart disease, including statins to control cholesterol, aspirin to prevent blood clots, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors all prolong survival in patients with peripheral arterial disease (PAD). Peripheral arterial disease is associated with increased cardiovascular morbidity and mortality. Treatment guidelines recommend aggressive management of risk factors and lifestyle modifications. However, the potential benefit of cardiac medication in patients with PAD remains ill defined. In this prospective observational cohort study, 2,420 consecutive patients (age 64 +/- 11 years, 72% men) with PAD (ankle-brachial index <= 0.90) were screened for clinical risk factors and cardiac medication. Follow-up end point was death from any cause. Propensity scores for statins, beta-blockers, aspirin, ACE inhibitors, calcium channel blockers, diuretics, nitrates, coumarin, and digoxin were calculated. Cox regression models were used to analyze the relation between cardiac medication and long-term mortality. Medical history included diabetes mellitus in 436 patients (18%), hypercholesterolemia in 581 (24%), smoking in 837 (35%), hypertension in 1,162 (48%), coronary artery disease in 1,065 (44%), and a history of heart failure in 214 (9%). Mean ankle-brachial index was 0.58 (+/-0.18). During a median follow-up of 8 years, 1,067 patients (44%) died. After adjustment for risk factors and propensity scores, statins (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.36 to 0.58), beta-blockers (HR 0.68, 95% CI 0.58 to 0.80), aspirins (HR 0.72, 95% CI 0.61 to 0.84), and ACE inhibitors (HR 0.80, 95% CI 0.69 to 0.94) were significantly associated with a reduced risk of long-term mortality.