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Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics pp 105–127Cite as

Circadian and Cyclic Environmental Determinants of Blood Pressure Patterning and Implications for Therapeutic Interventions

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Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

Abstract

Blood pressure (BP) exhibits significant 24 h variation; in most normotensive and uncomplicated hypertensive persons, BP declines during the first half of nighttime sleep by 10–20 % from its daytime mean level, starts rising in the second half of sleep, further increases with commencement of diurnal activity, and peaks in the afternoon or early evening. Environmental 24 h cycles of temperature and noise; behavior-driven nyctohemeral patterning of food, liquid, and stimulant consumption, posture, mental and emotional stress, and physical activity; plus innate circadian rhythms in wake/sleep, autonomic nervous, hypothalamic–pituitary–adrenal, renal hemodynamic, opioid, renin–angiotensin–aldosterone, endothelial, and vasoactive peptide systems constitute the key determinants of the BP day/night variation. The current perspective is that the environmental and behavioral cycles are far more influential than the innate circadian ones in determining the BP nyctohemeral profile. Yet, the facts that the: (1) BP 24 h pattern of secondary hypertension, e.g., diabetes and other endocrine disorders, renal disease, heart failure, is different—BP fails to decline as expected during nighttime sleep typically due to pathological alteration of autonomic nervous system and other influential circadian rhythms, and (2) scheduling of conventional long-acting medications at bedtime, rather than in the morning, results in much better hypertension control and vascular risk reduction, presumably because highest drug concentration coincides closely with the peak of most key circadian determinants of the BP 24 h profile, indicates the endogenous rhythmic influences are of much greater importance than previously appreciated.

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Abbreviations

ABPM:

Ambulatory blood pressure monitoring

ACE:

Angiotensin converting enzyme

ACEIs:

Angiotensin converting enzyme inhibitor medications

ACTH:

Adrenocorticotropic hormone

ANG II:

Angiotensin II

ANP:

Atrial natriuretic peptide

ANS:

Autonomic nervous system

ARBs:

Angiotensin receptor blocker medications

AT1 receptor:

Angiotensin type-1 receptor

BP:

Blood pressure

BTCT:

Bedtime chronotherapy: full dose of one or more hypertension medications ingested at bedtime

CCBs:

Calcium-channel blocker medications

cGMP:

Cyclic guanosine monophosphate

CGRP:

Calcitonin gene-related peptide

Cl:

Chloride

CMTT:

Conventional morning time therapy: full dose of one or more hypertension medications ingested upon morning awakening

CO:

Cardiac output

CRH:

Corticotropin-releasing hormone

CV:

Cardiovascular

DBP:

Diastolic blood pressure

EEG:

Electroencephalography

ET-1:

Endothelin 1

FMD:

Brachial artery flow-mediated endothelium-dependent vasodilatation

GFR:

Glomerular filtration rate

h:

Hour

HOPE:

Heart outcomes prevention evaluation trial

HPAA:

Hypothalamic–pituitary–adrenal axis

HPTA:

Hypothalamic–pituitary–thyroid axis

HR:

Hazard ratio

ipRGC:

Intrinsic photoreceptive retinal ganglion cells

K:

Potassium

MAPEC trial:

Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares (English: Ambulatory blood pressure monitoring for prediction of cardiovascular events)

min:

Minutes

MTCT:

Morning-time conventional therapy

Na:

Sodium

NO:

Nitric oxide

NREM:

Non-rapid eye movement sleep

PRA:

Plasma renin activity

RAAS:

Renin–angiotensin–aldosterone system

REM:

Rapid eye movement sleep

SBP:

Systolic blood pressure

SCN:

Suprachiasmatic nuclei

s:

Seconds

SNS:

Sympathetic nervous system

TPR:

Vascular total peripheral resistance

TRH:

Thyrotropin-releasing hormone

TSH:

Thyroid stimulating hormone

Ultradian:

Oscillations with period less than 20 h

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Authors and Affiliations

  1. Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, 107 W. Dean Keaton St., Austin, TX, 78712-0238, USA

    Michael H. Smolensky Ph.D.

  2. Hypertension Center, S. Anna University Hospital, University of Ferrara, Ferrara, Italy

    Francesco Portaluppi M.D., Ph.D.

  3. Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Vigo, Spain

    Ramón C. Hermida Ph.D.

Authors
  1. Michael H. Smolensky Ph.D.
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  2. Francesco Portaluppi M.D., Ph.D.
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  3. Ramón C. Hermida Ph.D.
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Correspondence to Michael H. Smolensky Ph.D. .

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Editors and Affiliations

  1. Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA

    William B. White

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Smolensky, M.H., Portaluppi, F., Hermida, R.C. (2016). Circadian and Cyclic Environmental Determinants of Blood Pressure Patterning and Implications for Therapeutic Interventions. In: White, W. (eds) Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics. Clinical Hypertension and Vascular Diseases. Humana Press, Cham. https://doi.org/10.1007/978-3-319-22771-9_6

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