Diurnal Blood Pressure Rhythm Research Articles

Behavioral influences on diurnal blood pressure rhythms.

Annals of the New York Academy of SciencesVolume 783, Issue 1 p. 132-140 Behavioral Influences on Diurnal Blood Pressure Rhythms THOMAS G. PICKERING, THOMAS G. PICKERING Hypertension Center New York Hospital-Cornell University Medical Center New York, New York 10021Search for more papers by this authorJOSEPH E. SCHWARTZ, JOSEPH E. SCHWARTZ Department of Psychiatry State University of New York at Stonybrook Stonybrook, New YorkSearch for more papers by this authorARTHUR STONE, ARTHUR STONE Hypertension Center New York Hospital-Cornell University Medical Center New York, New York 10021Search for more papers by this author THOMAS G. PICKERING, THOMAS G. PICKERING Hypertension Center New York Hospital-Cornell University Medical Center New York, New York 10021Search for more papers by this authorJOSEPH E. SCHWARTZ, JOSEPH E. SCHWARTZ Department of Psychiatry State University of New York at Stonybrook Stonybrook, New YorkSearch for more papers by this authorARTHUR STONE, ARTHUR STONE Hypertension Center New York Hospital-Cornell University Medical Center New York, New York 10021Search for more papers by this author First published: August 1996 https://doi.org/10.1111/j.1749-6632.1996.tb26712.xCitations: 12AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume783, Issue1Time‐Dependent Structure and Control of Arterial Blood PressureAugust 1996Pages 132-140 RelatedInformation

Parasympathetic and sympathetic influence on diurnal blood pressure rhythm

Parasympathetic and sympathetic influence on diurnal blood pressure rhythm

Effect of chronic YM-358, a nonpeptide AT<sub>1</sub> receptor antagonist, on diurnal rhythm of blood pressure, heart rate and locomotor activity in stroke-prone spontaneously hypertensive rats

Effect of chronic YM-358, a nonpeptide AT<sub>1</sub> receptor antagonist, on diurnal rhythm of blood pressure, heart rate and locomotor activity in stroke-prone spontaneously hypertensive rats

Diurnal blood pressure curve in children and adolescents

To investigate the diurnal blood pressure curve in healthy normotensive children. Thirty-one children were re-examined after a median interval of 123 days in order to study the reproducibility of the diurnal profile. Twenty-four-hour ambulatory blood pressure monitoring and conventional blood pressure readings were obtained in 228 normotensive children, whose ages ranged from 6 to 16 years and of whom 116 were boys and 112 girls. The conventional blood pressure averaged 99+/-11/57+/-9 mmHg in boys and 98+/-12/56+/-9 mmHg in girls (means+/-SD); the corresponding 24 h pressures were 111+/-7/66+/-5 mmHg and 109+/-7/65+/-5 mmHg, respectively. Of the children, 83% had a significant diurnal blood pressure rhythm for systolic pressure and 89% for diastolic pressure. The nocturnal blood pressure fall was normally distributed, averaging 12.0+/-6.3 mmHg systolic and 14.2+/-5.9 mmHg diastolic. There was no evidence for a bimodal distribution. The amplitude of the diurnal blood pressure curve, determined by the Fourier approach, was positively skewed with a mean of 12.5+/-4.2 mmHg for systolic and 14.0+/-4.1 mmHg for diastolic blood pressure. The daily blood pressure maximum occurred at 1344+/-4 h 46 min for systolic and 1321+/-4 h 22 min for diastolic blood pressure. For systolic blood pressure the cumulative sum (cusum)-derived circadian alteration magnitude was 1.7+/-6.2 mmHg higher in boys than in girls, whereas the cusum plot height was also 7.3+/-27.0 mmHg x h higher in male subjects. The repeatability coefficient (2SD of the difference between paired recordings, expressed as a percentage of nearly maximal variation) was 80% for the conventional systolic pressure and 40% for the conventional diastolic blood pressure. The repeatability coefficients for the ambulatory blood pressure levels varied from 32 to 45% and for the parameters describing the diurnal blood pressure profile from 42 to 78%. A significant diurnal blood pressure rhythm is observed in most normotensive children and adolescents. There is no evidence for a bimodal distribution of the nocturnal blood pressure fall. The reproducibility of the parameters of the diurnal blood pressure curve tended to be less than that of the ambulatory blood pressure level. Thus, one 24 h recording is probably insufficient to characterize a child's diurnal blood pressure profile fully.

Omega-3 polyunsaturated fatty acid supplements and ambulatory blood pressure monitoring parameters in patients with mild essential hypertension

To evaluate the effects of low doses of omega-3 polyunsaturated fatty acids on ambulatory blood pressure monitoring parameters in a group of mild essential hypertensives. We studied 24 consecutive essential hypertensive patients from our outpatient clinic with mild hypertension (diastolic blood pressure < or = 105 mmHg), no previous treatment for 4 weeks at least and no other disease. After a 3-month run-in period, the patients entered an intervention phase and were given 3 g omega-3 polyunsaturated fatty acids (85% eicosapentaenoic and docosahexaenoic acid concentrate) daily for 4 months; this phase was followed by a 4-month washout period. Ambulatory blood pressure monitoring was performed at the end of each phase; erythrocyte membrane fatty acids were assessed to check compliance. After 4 months of treatment, erythrocyte omega-3 polyunsaturated fatty acids significantly increased but average systolic and diastolic blood pressure and the heart rate did not significantly change; no significant variations were recorded in blood pressure or heart rate variability (assessed as blood pressure and heart rate SD) nor in the diurnal blood pressure rhythm. After washout, a significant decrease was observed in erythrocyte omega-3 polyunsaturated fatty acids but the ambulatory blood pressure monitoring parameters were not substantially modified. The present data show that low doses of omega-3 polyunsaturated fatty acids as a single treatment are not effective in lowering blood pressure or the heart rate in mild essential hypertensive patients, despite a significant change in fatty acid cell membrane composition. Nor does this treatment seem likely to affect blood pressure variability or the diurnal rhythm.

24-Hour Blood Pressure Profile in Addison’s Disease

The purpose of this study was to evaluate the circadian blood pressure rhythmicity in patients with primary adrenal insufficiency. Ten newly diagnosed and untreated patients with Addison's disease, 17 addisonian patients (including the previous 10) following an adequate regimen of corticosteroid replacement therapy, and 15 healthy subjects as a control group were studied. Twenty-four-hour ambulatory blood pressure and heart rate were measured automatically every 30 min using a Takeda TM-2420 recorder. The runs test, used for detecting blood pressure diurnal rhythm, was compatible with a rhythm in 2 of 10 patients with untreated Addison's disease, in 13 of 17 patients with treated Addison's disease, and in 13 of 15 normals. Six of eight addisonian patients showing no evidence of blood pressure rhythm in the untreated state acquired circadian periodicity during therapy. An analysis of blood pressure readings by Fourier series with four harmonics showed that blood pressure mesor was lower in untreated than in treated addisonian and normal subjects (P < .05). The nocturnal fall was smaller for systolic and diastolic blood pressure in untreated than in treated addisonian and normal subjects (P < .05). Adrenocortical insufficiency is often characterized by loss of circadian blood pressure rhythm, and normal rhythm can be reestablished by replacement therapy. Lack of cortisol rhythm or persistent activation of the renin-angiotensin system and sympathetic tone may play a role in this phenomenon.

Association of a nocturnal rise in plasma alpha-atrial natriuretic peptide and reversed diurnal blood pressure rhythm in hospitalized normotensive subjects with non-insulin dependent diabetes mellitus.

Diurnal changes in plasma atrial natriuretic peptide (ANP), plasma renin activity (PRA) and plasma aldosterone as related to those in blood pressure (BP) were studied under hospital conditions in 18 diabetic subjects without proteinuria and 8 age-matched control subjects. Of 18 diabetic subjects, 10 had a normal diurnal BP rhythm with the peak value in the afternoon (group 1) and 8 had a reversed BP rhythm with the peak value during the night (group 2). Autonomic dysfunction estimated by measuring orthostatic BP and heart-rate changes and beat-to-beat heart-rate variations was more pronounced in group 2 than in group 1. Fasting plasma glucose and HbA1c were similarly high in both diabetic groups. Group 1 showed modestly elevated mean 24-h MBP and plasma ANP levels, modestly low mean 24-h PRA and plasma aldosterone levels, and a lack of diurnal ANP changes similar to that in controls. Group 2 showed markedly elevated mean 24-h BP and plasma ANP levels, markedly low mean 24-h PRA and plasma aldosterone levels, and nocturnal rises in plasma ANP and BP. PRA and plasma aldosterone exhibited circadian rhythms with their peak values found in the early morning in all three groups. The daytime/overnight excretion ratios of sodium and water were normal in group 1 and low in group 2. These results indicate that diurnal changes in plasma ANP, PRA and plasma aldosterone are altered in diabetic subjects with normal and reversed diurnal BP rhythms, predominantly in the latter.

Statistical evaluation of circadian blood pressure rhythm during isradipine long-term therapy.

In this study, using the two-step truncated Fourier series with four harmonics, we analysed the diurnal blood pressure profile in 13 mild-moderate essential hypertensive patients during isradipine long-term therapy. Circadian parameters such as the amplitudes and phases of the four harmonics and the overall amplitude and phase were obtained from the model. The total duration of the study was 26 weeks. Ambulatory blood pressure was measured at 15-min, intervals using a Takeda TM 2420 device after 2 weeks of placebo and after 6 and 26 weeks of isradipine (5 mg daily) respectively. After 6 and 26 weeks therapy the blood pressure values showed a significant decrease, although the daily blood pressure curves obtained from Fourier analysis showed that the circadian rhythm was not altered by isradipine treatment. Both the night/day differences and the overall amplitude/acrophases were statistically significant at 0.6 and 26 weeks. According the nocturnal blood pressure fall, we found that long-term therapy with isradipine increased the number of patients with nocturnal blood pressure fall and reducing the early morning blood pressure rise. In conclusion, the two-step method Fourier analysis represents a novel and useful statistical approach to evaluate the presence of a significant diurnal blood pressure rhythm and to provide the circadian parameters of the 24-h blood pressure profile during pharmacological therapy.

Ambulatory blood pressure and prognosis

PROGNOSTIC INFORMATION: Ambulatory blood pressure monitoring provides three kinds of information, all of which might have prognostic significance: blood pressure level, amplitude of diurnal variation and short-term variability. BLOOD PRESSURE LEVEL: Existing data support the hypothesis that patients whose ambulatory blood pressure is low in comparison with clinic blood pressure (white-coat hypertension) have a relatively low risk of morbidity. AMPLITUDE OF DIURNAL RHYTHM OF BLOOD PRESSURE: While there is limited support for the hypothesis that patients with small diurnal variations may carry a higher risk (particularly women), opposing hypotheses are also plausible. SHORT-TERM BLOOD PRESSURE VARIABILITY: It is hypothesized that increased variability will be associated with increased morbidity. Preliminary data from the Cornell prospective study are consistent with this hypothesis.

Diurnal blood pressure rhythm and urinary catecholamine excretion in obstructive sleep apnoea and essential hypertension

Lapiski, Mariusz; Przybylowski, Tadeusz; Lewandowski, Jacek; Januszewicz, Andrzej; Wocial, Bozenna; Kowalski, Janusz; Droszcz, Waclaw; Januszewicz, WlodzimierzAuthor Information

Determinants and Consequences of the Diurnal Rhythm of Blood Pressure

The diurnal rhythm of blood pressure (BP) is influenced by both extrinsic and intrinsic factors, with the former usually being of greater significance. Non-dippers, in whom the normal nocturnal fall of pressure is diminished, have been reported to show more target organ damage (left ventricular hypertrophy (LVH)) than dippers, which may be explained by a higher average 24 h BP. Whether or not the pattern of BP (as opposed to the level) also is prognostically important is probable but unproven, given the known morning surge of the incidence of many acute cardiovascular events. The pathological significance of different diurnal patterns of BP change may depend both on the method of analysis and on the outcome measure used.

Blood pressure variability and ambulatory monitoring

The inherent variability of blood pressure means that the accuracy of a small number of clinic readings in estimating the true blood pressure is limited. In many patients, a clinic visit provokes an increase in blood pressure such that they may be misclassified as being hypertensive (white coat hypertension). This applies to about 20% of hypertensives. Ambulatory monitoring has the potential to overcome these limitations. The white coat effect may still occur in patients taking antihypertensive medications, although in some cases medication may lower the clinic pressure without affecting the ambulatory pressure. The diurnal rhythm of blood pressure is another major source of variability and is influenced by both extrinsic and intrinsic factors. Its pathologic significance is unclear. Antihypertensive medication generally lowers the set point of blood pressure but has relatively little effect on variability.

血圧日内変動におよぼす性，加齢の影響

In order to evaluate the effect of gender and aging on the diurnal rhythm of blood pressure (BP), we performed ambulatory BP monitoring in 267 normotensive volunteers (mean age +/- SD 52.1 +/- 24.6 years, range 16-93 years, 114 men, 153 women). Ambulatory 24-hour BP was recorded every 30 minutes with an oscillometric method by ABPM630 (Nippon-Kolin, Japan). Circadian rhythm was determined by fitting the 24-hour cosine function curve. Subjects were divided into three age groups, consisting of the Y group (age < 30), M group (age > or = 30 but < 60), and E group (age > or = 60). Highest normal values of the 24-hour mean BP (90 percentile of the values) were 126/75 mmHg in the Y group, 126/76 mmHg in the M group, and 154/85 mmHg in the E group in men. They were 117/67 mmHg, 125/77 mmHg 151/79 mmHg respectively in women. The MESOR of SBP increased with age in women, though it was significantly higher only in the E group among men. The amplitude of SBP decreased with age significantly only in men. The acrophase of SBP shifted to an earlier time of day with aging in both men and women. The trends in the circadian rhythm of DBP with age were similar to those of SBP. In conclusion, the circadian rhythm of blood pressure varies with gender and aging. The 24-hour blood pressure values should be considered with evaluating sex-age matched reference values.

Torasemide in comparison with thiazides in the treatment of hypertension

There are a number of clinically relevant differences between torasemide and the thiazide diuretics in the treatment of hypertension. Only 2.5-5 mg torasemide once daily is sufficient for antihypertensive treatment; these low doses of torasemide exert comparable antihypertensive effects to those of the overtly natriuretic doses of thiazides (e.g., hydrochlorothiazide 25 mg) that are currently used once daily for the treatment of hypertension. Whereas natriuretic thiazide doses reduce blood pressure rapidly, the blood pressure-lowering effect of low-dose torasemide appears to occur more gradually during the first weeks of treatment. The diurnal blood pressure rhythm is not altered by either drug. In contrast to the thiazides, torasemide does not cause significant renal potassium loss in doses recommended to treat hypertension. Long-term antihypertensive treatment with torasemide has not resulted in undesired metabolic side effects, such as hypomagnesemia, alterations in glucose and lipid metabolism, or hyperuricemia. As compared with the thiazides, torasemide appears to be a safer and equally effective alternative for antihypertensive treatment when subdiuretic doses of this loop diuretic are used.

Diurnal blood pressure profile in patients with severe congestive heart failure: Dippers and non-dippers

Patients with severe congestive heart failure (CHF) have increased sympathetic nervous activity and altered baroreceptor function, which may influence the diurnal blood pressure rhythm. The 24-h blood pressure profile was measured in 25 patients with severe CHF (mean ejection fraction: 17%) and 25 control subjects. Systemic blood pressure was measured automatically at the arm by a non-invasive blood pressure monitoring system every 15 min. The mean +/- SD systolic blood pressure in CHF patients and controls was during day-time 105 +/- 10 and 130 +/- 11 mm Hg and night-time 97 +/- 10 and 112 +/- 10 mm Hg, i.e. the nocturnal decrease was 9 +/- 6 and 18 +/- 8 mm Hg, respectively (p < 0.0005 for all). The subjects could be divided into two groups: dippers and non-dippers, with and without a relative decrease in nocturnal systolic blood pressure > 10%. There was significantly more non-dipping CHF patients (16) than controls (5) (p < 0.01). Systolic blood pressure was in CHF dippers vs. non-dippers during day-time: 108 +/- 7 vs. 104 +/- 12 mm Hg (NS) and night-time: 92 +/- 7 vs. 99 +/- 11 mm Hg (p = 0.08). The nocturnal decrease was 16 +/- 3 vs. 5 +/- 4 mm Hg and the relative nocturnal decrease 15 +/- 3 vs. 5 +/- 3% (p < 0.00001 for both). It is concluded that patients with severe congestive heart failure can be divided into two groups: dippers and non-dippers, with and without a normal decrease in nocturnal blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

The diurnal blood pressure profile. A population study.

This population study included 399 subjects, of whom 370 (93%) showed a significant diurnal blood pressure (BP) rhythm. The nocturnal BP fall was normally distributed and averaged 16 +/- 9 mm Hg systolic and 14 +/- 7 mm Hg diastolic (mean +/- SD). The amplitude of the diurnal BP curve followed a positively skewed distribution, with a mean of 16 +/- 5 mm Hg for systolic BP and 14 +/- 4 mm Hg for diastolic BP. The daily BP maximum occurred at 15:54 +/- 4:47 for systolic BP and at 15:11 +/- 4:20 for diastolic BP. Thirty-four subjects were reexamined after a median interval of 350 days. The test for the presence of a significant diurnal rhythm was discordant in only two subjects. Repeatability (twice the standard deviation of the differences between paired recordings expressed as a percentage of the mean) varied from 11 to 25% for the 24 h, daytime, and overnight BP, and from 76 to 138% for the parameters describing the diurnal BP rhythm. In nine subjects with an initial night/day ratio of mean BP less than 0.78, the nighttime BP was significantly increased at the repeat examination, whereas the opposite tendency was observed in nine subjects with an initial ratio greater than 0.87. In conclusion, the distribution of the nocturnal BP fall is unimodal. The reproducibility of the ambulatory BP is satisfactory for the level of BP and for the presence of a diurnal BP rhythm, but not for the parameters of the diurnal BP curve. Thus, one 24 h recording is insufficient to fully characterize an individual's diurnal BP profile.

Application of the chronopharmagological methods in clinicopharmacological studies. The effect of bopindolol on the diurnal rhythm of blood pressure in patients suffering from essential hypertension

Application of the chronopharmagological methods in clinicopharmacological studies. The effect of bopindolol on the diurnal rhythm of blood pressure in patients suffering from essential hypertension

Circadian Rhythm of Blood Pressure: Internal and External Time Triggers

Diurnal blood pressure (BP) fluctuations are superimposed by a 24-h rhythm with usually lower levels during the night and higher levels during the day. In contrast to other rhythmic bioparameters, the diurnal BP rhythm is largely dependent on activity and sleep rather than on clock time. This has been demonstrated by the BP characteristics after shifted sleeping and working phases, during transition from sleep to wakefulness, and by the influence of sleep and activities on the 24-h BP curve during normal daily routines. Whereas the circadian rhythm of BP is predominantly governed by external time triggers, endogenous rhythmicity can only be detected by time microscopic analysis or in conditions where effects of external time triggers are almost excluded.

Aerobic fitness and the diurnal rhythm of blood pressure in adolescents.

We examined the effects of aerobic fitness and race on the diurnal rhythm of blood pressure of 175 healthy adolescents who performed a cycle ergometer maximal exercise test while oxygen consumption was measured. A median split of maximum oxygen consumption for boys and girls separately classified them as either "more-fit" or "less-fit" subjects. Ambulatory blood pressure recordings were also performed, and the data were analyzed for means while subjects were awake and asleep. Less-fit black boys had higher systolic pressures than more-fit black boys while awake (124 vs. 115 mm Hg; p less than 0.009) and asleep (117 vs. 108; p less than 0.001). Less-fit black boys also had higher systolic pressures than less-fit white boys while awake (114; p less than 0.002) and asleep (105; p less than 0.001), and they had higher systolic pressures than more-fit white boys while asleep (105; p less than 0.01). Less-fit black girls had higher systolic pressures than more-fit black girls while awake (116 vs. 109; p less than 0.004) and asleep (109 vs. 100; p less than 0.001). Less-fit black girls also had higher diastolic pressures than more-fit black girls while awake (71 vs. 66; p less than 0.002) and asleep (66 vs. 61; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-four-hour blood pressure is not dependent on endogenous circadian rhythm

The effects of shifted working and sleeping phases on the diurnal blood pressure rhythm were investigated in 15 physically working industrial shift workers at a slowly rotated three-shift system. Ambulatory 24-h blood pressure monitoring was performed during the morning and night shifts. In the two shifts the mean 24-h blood pressure was identical. There were no differences in the blood pressure levels in the sleeping phases or in the working periods between the two 24-h cycles. Diurnal blood pressure fluctuations had equal amplitudes. Corresponding to the lag between the working period there was a phase difference of 8 h between the 24-h blood pressure curves. At this lag, there was a high correlation between the mean hourly blood pressure values (r = 0.683). Twenty-four-hour blood pressure curves during the first and last day of a night shift were nearly equal. Thus the effects of shift rotation on the 24-h blood pressure profile were fully expressed within the first 24 hours. The immediate and complete adaptation of the 24-h blood pressure curve to shifted activity and sleeping phases indicates that activity determines the diurnal blood pressure profile. The blood pressure is largely independent of internal circadian rhythm.