Diurnal blood pressure variation and sympathetic activity

Grassı, Guıdo; Bombelli, Michele; Seravalle, Gino; Dell’Oro, Raffaella; Quartı-Trevano, Fosca

doi:10.1038/hr.2010.26

Cited by 91 publications

(62 citation statements)

References 39 publications

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“…22 The shorter, ultradian rhythms are more dependent on sympathetic activity caused by external and behavioral stimuli. 23 The most commonly used marker of BP rhythmicity is nocturnal dipping that has been shown to be an important independent risk factor for cardiovascular disease. 11,24 Our results confirm that the nighttime dipping of BP is reduced in children born SGA, as already found in prepubertal, low birth weight children, 25,26 and in children with primary 27 or secondary hypertension attributed to chronic kidney disease.…”

Section: Discussionmentioning

confidence: 99%

Altered Cardiovascular Rhythmicity in Children Born Small for Gestational Age

et al. 2012

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Abstract-Low birth weight is frequently associated with a disproportionately high incidence of cardiovascular disease, diabetes mellitus, and kidney disease in adulthood. Epidemiological studies have identified an inverse association between low birth weight or being small for gestational age and hypertension in adulthood. We hypothesized that children born with low birth weight might have altered circadian and ultradian cardiovascular rhythmicity independent of the prevailing blood pressure level. Twenty-four-hour ambulatory blood pressure and heart rate rhythmicity was prospectively evaluated by Fourier analysis in a cohort of healthy children born with low birth weight and compared with normative pediatric data. Seventy-five children born small for gestational age (mean age, 8.1Ϯ2.2 years) and 139 controls matched for age and sex were investigated. In addition to increased 24-hour, daytime, and especially nighttime blood pressure levels (PϽ0.05), children born small for gestational age exhibited blunted circadian (24-hour) and ultradian (12-, 8-, and 6-hour) blood pressure rhythmicity (PϽ0.05). In a multivariate analysis including children born with low birth weight and controls, being born with low birth weight independently influenced ultradian blood pressure rhythmicity, whereas in a multivariate analysis including children born with low birth weight only, circadian and ultradian rhythms were independently influenced by catch-up growth, gestational age, and blood pressure level. This study demonstrates blunted circadian and ultradian cardiovascular rhythmicity in prepubertal children born small for gestational age, independent from the presence of arterial hypertension. Circadian and ultradian rhythms may be sensitive indicators for detecting subtle early abnormalities of cardiovascular regulation. (Hypertension. 2012;60:865-870.)Key Words: small for gestational age Ⅲ low birth weight Ⅲ child Ⅲ blood pressure Ⅲ circadian and ultradian cardiovascular rhythmicity

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Section: Discussionmentioning

confidence: 99%

Altered Cardiovascular Rhythmicity in Children Born Small for Gestational Age

et al. 2012

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“…These changes in BP are largely attributed to mental and physical activities, and the sympathetic nervous system has a crucial role in the generation of diurnal BP variation. 9,[13][14][15] It has been shown that diurnal changes in BP coincide with changes in heart rate and the levels of plasma and urinary catecholamines. [13][14][15][16] It also has been shown that BP is high during nighttime working hours and low during daytime sleeping hours in shift workers, although the dip in BP during sleeping hours may be attenuated at the beginning of the night shift.…”

Section: Diurnal Bp Variation In Relation To Mental and Physical Actimentioning

confidence: 99%

“…9,[13][14][15] It has been shown that diurnal changes in BP coincide with changes in heart rate and the levels of plasma and urinary catecholamines. [13][14][15][16] It also has been shown that BP is high during nighttime working hours and low during daytime sleeping hours in shift workers, although the dip in BP during sleeping hours may be attenuated at the beginning of the night shift. 17,18 These results indicate that the endogenous clock has a minor role in the generation of BP variation associated with the awake and sleep cycle.…”

Section: Diurnal Bp Variation In Relation To Mental and Physical Actimentioning

confidence: 99%

Diurnal blood pressure variation and related behavioral factors

Kawano

2010

Hypertens Res

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Blood pressure (BP) varies according to many internal and external factors, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies throughout the day and night. These changes in BP are closely related to mental and physical activities, and the sympathetic nervous system mainly contributes to the diurnal variation in BP. Other behavioral factors, such as food consumption and obesity, dietary intake of sodium, drinking and smoking habits, consumption of coffee and tea, and bathing, also affect the diurnal variation in BP. Alterations in diurnal BP variation due to behavioral factors are frequently seen in patients with hypertension and can be classified as morning hypertension, daytime hypertension and nighttime hypertension. Appropriate lifestyle modifications may normalize or improve both the level and rhythm of BP in these patients. Hypertension Research (2011) 34, 281-285; doi:10.1038/hr.2010.241; published online 2 December 2010Keywords: ambulatory blood pressure monitoring; diurnal blood pressure variation; lifestyle; mental stress; physical activity INTRODUCTION Blood pressure (BP) varies according to many internal and external factors. There are several distinctive rhythmic variations in BP including diurnal (or circadian) variation, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies with changes in mental and physical activities during daytime and nighttime. [1][2][3][4] In addition to the awake and sleep cycle, many behavioral factors, such as mental stress, exercise, food consumption, changes in body weight, dietary intake of sodium and other electrolytes, drinking and smoking habits, consumption of coffee and tea, and bathing, influence both the level and variation in BP. [5][6][7][8] Understanding the influences of those behavioral factors on diurnal BP variation is important for the management of hypertension because alterations in diurnal BP variation due to behavioral factors are observed in many hypertensive subjects. 9,10 It has been shown that ambulatory BP monitoring is useful for assessing the influence of behavioral factors as well as the effects of lifestyle modifications on the level and pattern of BP throughout the day. 11,12 In this review article, I would like to summarize the effects of behavioral factors on diurnal BP variation with respect to the pathophysiology of hypertension and the effects of lifestyle modifications on 24-h BP.

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“…6 Nevertheless, there is growing evidence that sympathetic nerve activity contributes importantly to BP variability and the diurnal BP profile. 7,8 Normally, BP decreases during sleep by at least 10% of the awake value, and occurrence of 'dipping' correlates directly with the amount of deep sleep and inversely with indices of sleep fragmentation. 9 There has been great interest in the mechanisms and clinical significance of the 'dipper' or 'non-dipper' pattern of ambulatory BP profiles.…”

Section: Introductionmentioning

confidence: 99%

Non-dipping pattern of hypertension and obstructive sleep apnea syndrome

2010

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There is growing recognition of cardiovascular consequences of obstructive sleep apnea (OSA). Recurrent episodes of airway obstructions result in hypoxia and hypercapnia increasing sympathetic neural tone, which in turn causes vasoconstriction and marked increases in blood pressure (BP). BP response to OSA may be important in understanding the absence of nocturnal BP fall in the subgroup of hypertensive patients termed 'non-dippers'. Even mild sleep apnea can increase nocturnal BP through different mechanisms including hypoxemia, sympathetic activation, mechanical changes and disruption of normal sleep. Sleep apnea may be an important factor in determining the increased cardiovascular risk in hypertensive non-dippers. Effective treatment of sleep apnea may attenuate neurohumoral and metabolic abnormalities, improve diurnal BP control and conceivably reduce cardiovascular risk. This review examines the evidence linking OSA to non-dipping pattern of hypertension, and discusses potential mechanisms underlying this link. We will review first, prognostic value of nighttime BP; second, the cardiovascular consequences of sleep apnea; third, the evidence for altered diurnal BP profile in sleep apnea; fourth, the mechanisms contributing to both nocturnal and daytime hypertension in sleep apnea; fifth, the benefits of sleep apnea treatment and finally implications for hypertension management.

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Diurnal blood pressure variation and sympathetic activity

Cited by 91 publications

References 39 publications

Altered Cardiovascular Rhythmicity in Children Born Small for Gestational Age

Altered Cardiovascular Rhythmicity in Children Born Small for Gestational Age

Diurnal blood pressure variation and related behavioral factors

Non-dipping pattern of hypertension and obstructive sleep apnea syndrome

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