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Midday naps lower BP in patients with hypertension
NEW ORLEANS — Among patients with arterial hypertension, those who napped in midday had lower BP compared with those who did not take a nap, independent of dipping status, according to findings presented at the American College of Cardiology Scientific Session.
Researchers analyzed 212 patients with hypertension (mean age, 63 years; 54% women; mean BP, 129.9/76.7 mm Hg) to determine whether midday napping status affected BP in this population. Among the cohort, 74.6% did not have diabetes, 70.3% did not smoke and 81.4% did not consume alcohol.
Compared with no midday naps, those who reported napping had lower mean 24-hour ambulatory systolic BP (127.6 mm Hg vs. 132.9 mm Hg), daytime systolic BP (128.7 mm Hg vs. 134.5 mm Hg) and daytime diastolic BP (76.2 mm Hg vs. 79.5 mm Hg; P < .005 for all), according to the researchers.
“The patients who napped were predominantly older, but nonetheless had lower blood pressure levels in comparison to those did not have a habit of sleep during midday,” Manolis Kallistratos, MD, cardiologist at the Asklepieion General Hospital in Voula, Greece, said during a consumer web briefing. “On the other hand, we didn’t have any other differences in terms of echocardiographic parameters.”
There was no correlation between the BP/napping relationship and dipping status.
When the researchers conducted a linear regression model, each 60 minutes of midday sleep was associated with a 3-mm Hg decrease in 24-hour ambulatory systolic BP (P < .001).
“Some people may argue that this blood pressure decrease may be small, but we know a decrease in systolic BP as small as 3 mm Hg may decrease risk for cardiovascular events by as much as 10%,” Kallistratos said during the web briefing. “It appears that midday sleep is as potent as other lifestyle changes.”
“This is an important study in terms of showing the association between daytime naps and reduction in blood pressure,” Salim Virani, MD, PhD, FACC, chair of the ACC Council for the Prevention of Cardiovascular Disease and professor in the section of cardiovascular research at Baylor College of Medicine, said during the web briefing. “Obviously it does not take away from the emphasis on reduction of other risk factors.”– by Erik Swain
Reference:
Poulimenos L, et al. Abstract 1332-439. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.
Disclosures: Kallistratos and Virani report no relevant financial disclosures.
Perspective
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This study is hypothesis-generating, but not necessarily definitive. It was not a randomized evaluation. The people who napped having lower BP might have been because there was some selection that led them to nap. Perhaps they were taking more medications or the medications they were taking made them more sleepy. There are many possibilities that could account for the findings.
This is a different way of looking at this question, but whether it is a valid therapy would depend on a randomized trial where you encourage some people to nap and don’t let others nap, and see how everyone responds.
This would be another lifestyle modification that could be employed outside the realm of drug therapy that would go along with others such as relaxation response, exercise and weight loss. There is a menu of options that patients can partake of.
What would be the mechanism by which this works? I presume it would intersect in some way with the central nervous system to control BP. It might be that those who nap take beta-blockers, or don’t take them. There is a lot of analysis that is not present in the abstract or slides, but this is an interesting topic that is worth further investigation. It may be part and parcel of the relaxation response/meditation/brain over matter sphere. Our team has done a lot of work in this area and I do believe in it.
Massachusetts General Hospital
Associate Professor of Medicine,
Harvard Medical School
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