Circadian mechanisms of 24-hour blood pressure regulation and patterning
Abstract
In most persons, blood pressure (BP) rises slowly during late sleep, increases rapidly upon morning awakening and commencement of diurnal activity, exhibits two - morning and afternoon/early evening - daytime peaks, shows a minor midday nadir, and undergoes a decline during nighttime sleep by 10-20% in systolic BP and somewhat lesser amount in diastolic BP relative to wake-time means. Nyctohemeral cycles of ambient temperature, light, noise and behaviorally driven temporal patterns in food, liquid, salt, and stimulant consumption, mental/emotional stress, posture, and physical activity intensity plus circadian rhythms of wake/sleep, pineal gland melatonin synthesis, autonomic and central nervous, hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, renin-angiotensin-aldosterone, renal hemodynamic, endothelial, vasoactive peptide, and opioid systems constitute the key regulators and determinants of the BP 24 h profile. Environmental and behavioral cycles are believed to be far more influential than circadian ones. However, the facts that the: i) BP 24 h pattern of secondary hypertension, e.g., diabetes and renal disease, is characterized by absence of BP fall during sleep, and ii) scheduling of conventional long-acting medications at bedtime, rather than 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, indicate endogenous rhythmic influences are of greater importance than previously appreciated.
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Candidate mechanisms for elevated cardiovascular disease risk due to shift work include disrupted 24-hour rhythms of blood pressure and vascular function, atherosclerosis, proinflammatory states, and altered lipid and glucose metabolism.
“Candidate mechanisms underlying elevated risk for CVD due to shift work include disrupted 24-hour rhythms of blood pressure [84] and vascular function [85], atherosclerosis [86], proinflammatory states [87], and altered lipid and glucose metabolism [88].”
From Shift Work: Disrupted Circadian Rhythms and Sleep—Implications for Health and Well-being (2017) · cites this paper as [84]
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Diurnal variation in blood volume of man
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Shift Work: Disrupted Circadian Rhythms and Sleep—Implications for Health and Well-being
James, S. M., Honn, K. A., Gaddameedhi, S., & Van Dongen, H. P. A. (2017) · Current Sleep Medicine Reports · doi:10.1007/s40675-017-0071-6 · Cited by 517 · see citing works
Ballesta, A., Innominato, P. F., Dallmann, R., Rand, D. A. J., & Lévi, F. (2017) · Pharmacological Reviews · doi:10.1124/pr.116.013441 · Cited by 342 · see citing works
“These include heart rate; blood pressure; peripheral vascular resistance; blood volume; circulating and intracellular concentrations of potassium, sodium, and other ions; and circulating plasma levels of proteins and albumin, as well as clock genes and clock-controlled genes and proteins in heart and arteries (Portalu…”
BackgroundInfluentialCircadian clock-mediated regulation of blood pressure
Douma, L. G., & Gumz, M. L. (2017) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2017.11.024 · Cited by 267 · see citing works
Smolensky, M. H., Hermida, R. C., Reinberg, A., Sackett-Lundeen, L., & Portaluppi, F. (2016) · Chronobiology International · doi:10.1080/07420528.2016.1184678 · Cited by 197 · see citing works
“It is also strongly influenced by the nyctohemeral cycles of ambient temperature, light and noise and also the temporal patterning during the 24 h of mental/emotional stress, posture, physical activity, and nutrient, liquid, salt and stimulant consumption (Smolensky et al., 2016).”
BackgroundInfluentialSelf-citationVisioli, F., & Artaria, C. (2016) · Food & Function · doi:10.1039/c6fo01721e · Cited by 200 · see citing works
Sleep Disturbances as a Risk Factor for Stroke
Koo, D. L., Nam, H., THOMAS, R. J., & Yun, C. (2018) · Journal of Stroke · doi:10.5853/jos.2017.02887 · Cited by 150 · see citing works
The neurovascular unit and systemic biology in stroke — implications for translation and treatment
Tiedt, S., Buchan, A. M., Dichgans, M., Lizasoaín, I., Moro, M. Á., & Lo, E. H. (2022) · Nature Reviews Neurology · doi:10.1038/s41582-022-00703-z · Cited by 132 · see citing works
Timing in drug absorption and disposition: The past, present, and future of chronopharmacokinetics
Bicker, J., Alves, G., Falcão, A. C., & Fortuna, A. C. (2020) · British Journal of Pharmacology · doi:10.1111/bph.15017 · Cited by 98 · see citing works
“While cardiac output is higher during daytime, when sympathetic nervous system activity predominates, peripheral blood flow is decreased due to vasoconstriction (Smolensky et al., 2017).”
BackgroundElevated heart rate and nondipping heart rate as potential targets for melatonin: a review
Šimko, F., Baka, T., Paulis, L., & Reiter, R. J. (2016) · Journal of Pineal Research · doi:10.1111/jpi.12348 · Cited by 88 · see citing works
Blood-pressure variability in patients with obstructive sleep apnea: current perspectives
Marrone, O., & Bonsignore, M. R. (2018) · Nature and Science of Sleep · doi:10.2147/nss.s148543 · Cited by 81 · see citing works
“Twenty-four-hour BP changes are affected by endocrine influences, genetic factors, degree of diurnal physical and mental activity, and more than anything else by the wake–sleep cycle.(6,7) In normal subjects, BP decreases when falling asleep, reaches its lowest values and highest stability during slow-wave sleep (SWS)…”
Stergiou, G. S., Brunström, M., MacDonald, T. M., Kyriakoulis, K. G., Bursztyn, M., Khan, N. A., Bakris, G. L., Κόλλιας, Α., Menti, A., Muntner, P., et al. (2022) · Journal of Hypertension · doi:10.1097/hjh.0000000000003240 · Cited by 71 · see citing works
“Further to awake/asleep status, other extrinsic factors affecting BP fluctuations include physical and mental activities, ambient temperature and noise, dietary patterns (salt, coffee, tea, alcohol) and drugs affecting BP [2,3,39].”
BackgroundThe Circadian Biology of Heart Failure
Jamal, N. E., Lordan, R., Teegarden, S. L., Großer, T., & FitzGerald, G. A. (2023) · Circulation Research · doi:10.1161/circresaha.122.321369 · Cited by 70 · see citing works
Hermida, R. C., Ayala, D. E., Fernández, J. R., Mojón, A., & Smolensky, M. H. (2018) · European Journal of Clinical Investigation · doi:10.1111/eci.12909 · Cited by 65 · see citing works
“Interestingly, antagonism of the RAAS by reduction in angiotensin II formation and HERMIDA ET AL.”
MethodResultInfluentialSelf-citationBaschieri, F., & Cortelli, P. (2019) · Autonomic Neuroscience · doi:10.1016/j.autneu.2019.01.009 · Cited by 61 · see citing works
The chronobiology of migraine: a systematic review
Poulsen, A. H., Younis, S., Thuraiaiyah, J., & Ashina, M. (2021) · The Journal of Headache and Pain · doi:10.1186/s10194-021-01276-w · Cited by 60 · see citing works
“Circadian rhythms have the most pervasive influence on the many functions in the human body such as blood pressure [6], sleep-wake cycles, body temperature and hormone production [7].”
BackgroundGubin, D. G., Weinert, D., Rybina, S. V., Danilova, L. A., Solovieva, S. V., Михайлович, Д. А., Prokopiev, N. Y., & Ushakov, P. A. (2017) · Chronobiology International · doi:10.1080/07420528.2017.1288632 · Cited by 58 · see citing works
“…melatonin, the angiotensin converting enzyme, angiotensin II, the atrial natriuretic peptide, arginine vasopressin and endothelin 1, the plasma renin activity, the glomerular filtration rate, the total peripheral resistance and others (Portaluppi et al., 1996; Smolensky et al., 2016a,b).”
BackgroundInfluentialCircadian Blood Pressure Rhythm in Cardiovascular and Renal Health and Disease
Zhang, J., Sun, R., Jiang, T., Yang, G., & Chen, L. (2021) · Biomolecules · doi:10.3390/biom11060868 · Cited by 55 · see citing works
“BP, which is crucial to cardiovascular and renal health, displays obvious circadian rhythm with nocturnal dip and morning surge in both human and rodents [12].”
BackgroundPaterson, C. A., Fryer, S. M., Stone, K. J., Zieff, G. H., Turner, L. A., & Stoner, L. R. (2021) · Sports Medicine · doi:10.1007/s40279-021-01614-7 · Cited by 62 · see citing works
Hermida, R. C. (2016) · Chronobiology International · doi:10.1080/07420528.2016.1181078 · Cited by 52 · see citing works
Self-citationSmolensky, M. H., Hermida, R. C., & Geng, Y. (2020) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2020.10.014 · Cited by 52 · see citing works
Self-citationBlood pressure monitoring in sleep: time to wake up
Kwon, Y., Stafford, P. L., Lim, D. C., Park, S., Kim, S., Berry, R. B., & Calhoun, D. A. (2019) · Blood Pressure Monitoring · doi:10.1097/mbp.0000000000000426 · Cited by 52 · see citing works
Recent advances in modulators of circadian rhythms: an update and perspective
Huang, S., Jiao, X., Lu, D., Pei, X., Qi, D., & Li, Z. (2020) · Journal of Enzyme Inhibition and Medicinal Chemistry · doi:10.1080/14756366.2020.1772249 · Cited by 47 · see citing works
Weber, T., Protogerou, A. D., Agharazii, M., Argyris, A., Bahous, S. A., Banegas, J. R., Binder, R. K., Blacher, J., Brandao, A. A., Cruz, J. J., et al. (2021) · Hypertension · doi:10.1161/hypertensionaha.121.17765 · Cited by 46 · see citing works
Association between circadian disruption and diseases: A narrative review
Hou, Y., Liu, L.-M., Chen, X., Li, Q., & Li, J. (2020) · Life Sciences · doi:10.1016/j.lfs.2020.118512 · Cited by 45 · see citing works
Zhu, H., Zhao, Z., Liu, H., Cai, J., Lu, Q., Ji, L., & Xu, J. (2023) · Annals of Medicine · doi:10.1080/07853890.2023.2191218 · Cited by 41 · see citing works
Messineo, L., Sands, S. A., Schmickl, C. N., Gonzalo Labarca, T., Hu, W.-H., Esmaeili, N., Vena, D., Gell, L. K., Calianese, N. A., Malhotra, A., et al. (2024) · Hypertension · doi:10.1161/hypertensionaha.123.22444 · Cited by 40 · see citing works
“48 However, non-dippers in Q3 versus Q1 exhibited clinically meaningful reductions in posttreatment SBP (4.93 [95% CI, −0.59 to 10.45] mm Hg; P =0.079; Figure 2), suggesting that there is room for BP improvements also in nondippers upon nearly complete resolution of overnight hypoxia.”
BackgroundInfluentialCircadian rhythm and autonomic dysfunction in presymptomatic and early Huntington's disease
Diago, E. B., Pérez‐Pérez, J., Lasaosa, S. S., Viloria‐Alebesque, A., Martínez‐Horta, S., Kulisevsky, J., & del Val, J. L. (2017) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2017.09.013 · Cited by 40 · see citing works
“ABPM is used to objectively evaluate the circadian rhythm of BP, which fluctuates according to the subject's sleep-activity rhythm an d e dogenous circadian rhythms [12].”
MethodLi, R., Pan, Y., Chen, D., Xu, X., Yan, G., & Fan, T. (2022) · Pharmaceutics · doi:10.3390/pharmaceutics14020437 · Cited by 38 · see citing works
“It is a calcium channel blocker used clinically to treat hypertension and angina [23], which typically occur when a patient is just waking up in the morning [24,25].”
BackgroundHermida, R. C., Smolensky, M. H., Balan, H., Castriotta, R. J., Crespo, J. J., Dagan, Y., El‐Toukhy, S., Fernández, J. R., FitzGerald, G. A., Fujimura, A., et al. (2020) · Chronobiology International · doi:10.1080/07420528.2020.1850468 · Cited by 38 · see citing works
“…pathways of drug-targeted sites, such as blood vessels, heart and renal tissue plus (ii) comprise mechanisms of the 24 h BP pattern, especially the ANS and RAAS (Angeli et al. 1992; Fabbian et al. 2013; Hermida et al. 2007; Portaluppi et al. 2012; Smolensky et al. 2007, 2017; Sothern et al. 1995).”
BackgroundInfluentialSelf-citationChokesuwattanaskul, A., Cheungpasitporn, W., Thongprayoon, C., Vallabhajosyula, S., Bathini, T. J., Mao, M. A., Cato, L. D., & Chokesuwattanaskul, R. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.119.016299 · Cited by 37 · see citing works
“Selection Criteria To be included in the metaanalysis, studies were required to meet the following criteria: (1) observational studies including cohort, case- control, or crosssectional studies (2) reported the association of nondipping or reverse- dipping blood pressure patterns on WMH, ALI, CMBs, or enlarged PVS, (3…”
BackgroundWeber, T., Protogerou, A. D., Agharazii, M., Argyris, A., Bahous, S. A., Banegas, J. R., Binder, R. K., Blacher, J., Brandão, A. A., de la Cruz, J. J., et al. (2022) · Figshare · doi:10.17863/cam.79775 · Cited by 36 · see citing works
Hermida, R. C., Mojón, A., Hermida‐Ayala, R. G., Smolensky, M. H., & Fernández, J. R. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101454 · Cited by 36 · see citing works
Self-citationPioneering new frontiers in circadian medicine chronotherapies for cardiovascular health
Festus, I. D., Spilberg, J., Young, M. E., Cain, S. W., Khoshnevis, S., Smolensky, M. H., Zaheer, F., Descalzi, G., & Martino, T. A. (2024) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2024.02.011 · Cited by 35 · see citing works
Self-citationXin, M., Bi, F., Wang, C., Huang, Y., Xu, Y., Liang, S., Cai, T., Xu, X., Dong, L., Li, T., et al. (2024) · Journal of Advanced Research · doi:10.1016/j.jare.2024.04.005 · Cited by 34 · see citing works
“A healthy blood pressure rhythm in the human body tends to manifest as a low levels at nighttime and high levels at daytime, i.e., low blood pressure levels at night and rapidly increases in the early morning before and after awakening, which may be related to changes in hormone levels [200].”
Circadian Rhythm Disruptions and Cardiovascular Disease Risk: The Special Role of Melatonin
Nuszkiewicz, J., Rzepka, W., Markiel, J., Porzych, M., Woźniak, A., & Szewczyk‐Golec, K. (2025) · Current Issues in Molecular Biology · doi:10.3390/cimb47080664 · Cited by 36 · see citing works
“Some studies have reported enhanced nocturnal BP reduction and improved dipping status with such regimens [132,133], while others found no significant difference compared to morning dosing [134].”
Riegel, B. J., Daus, M., Lozano, A. J., Malone, S. K., Patterson, F., & Hanlon, A. L. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.119.013269 · Cited by 31 · see citing works
“Yet, well-controlled laboratory studies are devoid of environmental and behavioral factors that may also contribute to sympathetic nervous stimulation in shift workers, such as exposure to light, noise, caffeine consumption, and occupational stress during the night.(48) Collectively, these biological, environmental, a…”
BackgroundHermida, R. C., Hermida‐Ayala, R. G., Smolensky, M. H., Mojón, A., & Fernández, J. R. (2021) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2021.01.013 · Cited by 30 · see citing works
Self-citationKim, H., Ang, T. F. A., THOMAS, R. J., Lyons, M. J., & Au, R. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.13356 · Cited by 26 · see citing works
Chronobiological patterns of acute aortic dissection in central China
Xia, L., Huang, L. J., Feng, X., Xiao, J., Wei, X., & Yu, X. (2020) · Heart · doi:10.1136/heartjnl-2020-317009 · Cited by 26 · see citing works
Roberts, M. L., Kotchen, T. A., Pan, X., Li, Y., Yang, C., Liu, P., Wang, T., Laud, P. W., Chelius, T. H., Munyura, Y., et al. (2022) · Hypertension · doi:10.1161/hypertensionaha.121.18584 · Cited by 25 · see citing works
Hannemann, J., Laing, A., Middleton, B., Schwedhelm, E., Marx, N., Federici, M., Kastner, M., Skene, D. J., & Böger, R. H. (2023) · Pharmacological Research · doi:10.1016/j.phrs.2023.107011 · Cited by 26 · see citing works
Xiong, Y., Zhong, Q., Zhang, Y., Liu, Z., & Wang, X. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1338110 · Cited by 25 · see citing works
“Consequently, disruptions in circadian rhythms that lead to non-dipping nocturnal blood pressure (non-dipper hypertension) are associated with the occurrence and progression of CKD, although the underlying molecular mechanisms remain unclear (50, 51).”
BackgroundInterplay Between the Circadian Clock and Sirtuins
Zhuang, Y., Zhang, Y., Liu, C., & Zhong, Y. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252111469 · Cited by 25 · see citing works
“…of clock genes and clock-controlled genes, is widely involved in the regulation of various physiological processes, such as lipid metabolism, cholesterol synthesis, glucose metabolism and transport, and oxidative phosphorylation, and plays an important regulatory role in metabolism [125–127].”
BackgroundSleep Duration Irregularity and Risk for Incident Cardiovascular Disease in the UK Biobank
Huang, T., Kianersi, S., Wang, H., Potts, K. S., Noordam, R., Sofer, T., Rutter, M. K., & Redline, S. S. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.040027 · Cited by 26 · see citing works
“To facilitate comparison with previous studies and enhance interpretability, 8,9,21,22 we modeled sleep duration SD both in categories (≤30 [ref], 31–45, 46–60, 61–90, >90 minutes) and as a continuous variable (per 1-hour increase).”
Costello, H. M., Crislip, G. R., Cheng, K., Lynch, I. J., Juffre, A., Bratanatawira, P., McKee, A. R., Thelwell, R. S., Mendez, V. M., Wingo, C. S., et al. (2023) · Function · doi:10.1093/function/zqad001 · Cited by 24 · see citing works
Bedtime Blood Pressure Chronotherapy Significantly Improves Hypertension Management
Hermida, R. C., Ayala, D. E., Fernández, J. R., Mojón, A., Crespo, J. J., Ríos, M. T. P., & Smolensky, M. H. (2017) · Heart Failure Clinics · doi:10.1016/j.hfc.2017.05.010 · Cited by 24 · see citing works
Self-citationLiang, Q. L., Xu, H., Liu, M., Lei, Q., Yan, J., Yang, G., & Chen, L. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.121.025021 · Cited by 23 · see citing works
Hermida, R. C., Hermida‐Ayala, R. G., Smolensky, M. H., Mojón, A., & Fernández, J. R. (2020) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1080/17425255.2020.1825681 · Cited by 22 · see citing works
Self-citationShort Sleep Duration and Erectile Dysfunction: A Review of the Literature
Zhang, F., Xiong, Y., Qin, F., & Yuan, J. (2022) · Nature and Science of Sleep · doi:10.2147/nss.s375571 · Cited by 23 · see citing works
“Meanwhile, the circadian of angiotensin (Ang)-converting enzyme (ACE) has been demonstrated in subjects with normal blood pressure and uncomplicated hypertension and could be modified through sleep deprivation.(117,118) The circulatory Ang II and tissue angiotensin type-1 (AT1) receptor expression have revealed circad…”
BackgroundSansom, K., Reynolds, A. C., Dhaliwal, S. S., Walsh, J. H., Maddison, K. J., Singh, B., Eastwood, P. R., & McArdle, N. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13778 · Cited by 21 · see citing works
“Of note, in the present study, measures of BP were reported as the average of measures taken in the morning, afternoon and evening, which should minimise any circadian influence on our study outcome (Smolensky et al., 2017).”
BackgroundGeng, Y., Smolensky, M. H., Sum‐Ping, O., Hermida, R. C., & Castriotta, R. J. (2022) · Chronobiology International · doi:10.1080/07420528.2022.2080557 · Cited by 21 · see citing works
“This substantial redistribution of the cardiac output in normal sleepers along with various circadian rhythms (Smolensky et al. 2017) mediate the normal decline in SBP and DBP and normal dipper SBP 24 h phenotype.”
BackgroundInfluentialSelf-citationEllingson, C. J., Singh, J., Ellingson, C. A., Sirant, L. W., Krätzig, G. P., Dorsch, K. D., Piskorski, J., & Neary, J. P. (2022) · Life · doi:10.3390/life12091400 · Cited by 21 · see citing works
“For example, ANS activity fluctuates throughout the day as rhythmic circadian changes modulate endogenous physiological mechanisms [29].”
BackgroundAmbulatory blood pressure monitoring-based definition of true arterial hypertension
Hermida, R. C., Mojón, A., Fernández, J. R., Otero, A., Crespo, J. J., Domínguez-Sardiña, M., Ríos, M. T. P., & Smolensky, M. H. (2020) · Minerva Medica · doi:10.23736/s0026-4806.20.06834-2 · Cited by 18 · see citing works
Self-citationHannemann, J., Laing, A., Middleton, B., Cridland, J., Staels, B., Marx, N., Grant, P. J., Federici, M., Stenberg, D., Skene, D. J., et al. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002848 · Cited by 20 · see citing works
Guagliardo, N. A., Yao, J., Stipes, E. J., Cechova, S., Le, T. H., Bayliss, D. A., Breault, D. T., & Barrett, P. Q. (2019) · Hypertension · doi:10.1161/hypertensionaha.118.11962 · Cited by 20 · see citing works
Molčan, Ľ., Babarikova, K., Cvikova, D., Kincelova, N., Kubincova, L., & Šutovská, H. M. (2024) · Pflügers Archiv - European Journal of Physiology · doi:10.1007/s00424-023-02901-0 · Cited by 20 · see citing works
“In diurnal animals and humans, light stimulates the sympathetic nervous system [78].”
BackgroundYang, K., Wang, Y., Ding, Y., Cui, H., Zhou, D., Chen, L., Ma, Z., Wang, W., Zhang, W., & Luan, J. (2019) · Chronobiology International · doi:10.1080/07420528.2019.1610419 · Cited by 18 · see citing works
“A number of studies have shown components of the RAS system exhibit variations in circadian rhythm (Naito et al. 2014, 2009; Smolensky et al. 2017).”
BackgroundŠutovská, H. M., Molčan, Ľ., Koprdová, R., Piešová, M., Mach, M., & Zeman, M. (2020) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174420000963 · Cited by 18 · see citing works
Circadian rhythm in prostate cancer: time to take notice of the clock
Zhu, W., He, Q., Feng, D., Wei, Q., & Yang, L. (2022) · Asian Journal of Andrology · doi:10.4103/aja202255 · Cited by 18 · see citing works
Smolensky, M. H., Hermida, R. C., Ayala, D. E., Mojón, A., & Fernández, J. R. (2017) · Heart Failure Clinics · doi:10.1016/j.hfc.2017.05.011 · Cited by 17 · see citing works
Self-citationNobrega, A. K. D., Mellers, A. P., & Lyons, L. C. (2017) · Experimental Gerontology · doi:10.1016/j.exger.2017.07.014 · Cited by 18 · see citing works
“…al., 2009; Karatsoreos et al., 2011), diabetes (Kawakami et al., 2004; Spiegel et al., 2005), cardiovascular disease (Ha and Park, 2005; Kivimäki et al., 2006) and the onset of myocardial infarction and stroke (Malik et al., 1990; Scheer et al., 2009; Smolensky et al., 2016a; Tofler et al., 1987).”
BackgroundThe human circadian clock from health to economics
Koritala, B. S. C., & Çakmaklı, S. (2018) · PsyCh Journal · doi:10.1002/pchj.252 · Cited by 16 · see citing works
Does Timing of Antihypertensive Medication Dosing Matter?
Hermida, R. C., Hermida‐Ayala, R. G., Smolensky, M. H., Mojón, A., Crespo, J. J., Otero, A., Ríos, M. T. P., Domínguez-Sardiña, M., & Fernández, J. R. (2020) · Current Cardiology Reports · doi:10.1007/s11886-020-01353-7 · Cited by 17 · see citing works
Self-citationNew perspectives on the definition, diagnosis, and treatment of true arterial hypertension
Hermida, R. C., Smolensky, M. H., Mojón, A., Crespo, J. J., Ríos, M. T. P., Domínguez-Sardiña, M., Otero, A., & Fernández, J. R. (2020) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2020.1746274 · Cited by 17 · see citing works
“[9,12,13,15,17,18]; (ii) elevation of atrial natriuretic and calcitonin gene-related vasoactive peptides and nitric oxide as vasodilators [18,87]; and (iii) cardiac remodeling [88–90].”
BackgroundSelf-citationBaHammam, A. S., Alshahrani, M. M., Aleissi, S. A., Olaish, A. H., Alhassoon, M. H., & Shukr, A. (2021) · Scientific Reports · doi:10.1038/s41598-021-87200-3 · Cited by 16 · see citing works
Wu, H., Shi, L., Lin, Y. P., & Zheng, T. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.896054 · Cited by 17 · see citing works
Influência do sono e da crononutrição na hipertensão e diabetes: um estudo de base populacional
Quadra, M. R., Santos, L. P., Schäfer, A. A., & Meller, F. D. O. (2022) · Cadernos de Saúde Pública · doi:10.1590/0102-311xpt291021 · Cited by 19 · see citing works
Alostaz, M., Correa, S., Lundy, G. S., Waikar, S. S., & Causland, F. R. M. (2023) · Journal of Human Hypertension · doi:10.1038/s41371-022-00799-2 · Cited by 16 · see citing works
“● While in some HD patients BP follows this pattern in the interdialytic period, a high proportion of non-dipping (decreased night-time dip) has been reported.”
BackgroundYu, Y., Li, W., Xu, L., & Wang, Y. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1124353 · Cited by 16 · see citing works
“Almost all variables related to the cardiovascular system have a day/night pattern or circadian rhythms (32, 33), including the heart rate (34), blood pressure (34, 35), circulating catecholamines (36, 37), and vascular endothelial function (38).”
BackgroundJeong, J., Zhu, H., Harris, R. A., Dong, Y., Su, S., Tingen, M. S., Kapuku, G. K., Pollock, J. S., Pollock, D. M., Harshfield, G. A., et al. (2019) · American Journal of Hypertension · doi:10.1093/ajh/hpz083 · Cited by 16 · see citing works
Thakur, A., & Kishore, R. (2025) · Neurobiology of Sleep and Circadian Rhythms · doi:10.1016/j.nbscr.2025.100131 · Cited by 15 · see citing works
“For instance, blood pressure typically dips during sleep and rises in the early morning, a pattern regulated by the interplay between the SCN and peripheral clocks in the cardiovascular system (CVS) (Douma and Gumz, 2018; Smolensky et al., 2017; Faraci and Scheer, 2024; Hermida et al., 2011).”
Hermida, R. C., Mojón, A., Fernández, J. R., Hermida‐Ayala, R. G., Crespo, J. J., Ríos, M. T. P., Domínguez-Sardiña, M., Otero, A., & Smolensky, M. H. (2021) · Chronobiology International · doi:10.1080/07420528.2021.1939367 · Cited by 15 · see citing works
“…in enhanced protection against the deleterious cardiac, endothelial, and other tissue remodeling, pathology, and injury, which at this specific circadian time is considered to be of greatest risk (Fabbian et al. 2013; Hermida et al. 2017; Portaluppi et al. 2012; Smolensky et al. 2007, 2017).”
BackgroundInfluentialSelf-citationDas, M., Mohanty, S. R., Minocha, T., Mishra, N. K., Yadav, S. K., & Haldar, C. (2022) · Journal of Photochemistry and Photobiology B Biology · doi:10.1016/j.jphotobiol.2022.112508 · Cited by 15 · see citing works
Reinberg, A., Smolensky, M. H., Riedel, M., Riedel, C., Brousse, E., & Touitou, Y. (2017) · Chronobiology International · doi:10.1080/07420528.2017.1343833 · Cited by 15 · see citing works
“…to the low-amplitude first harmonic contribution to the 24h fundamental τ that comprises the usual multiplecomponent (12h + 24h) waveform of the circadian SBP and DBP pattern of healthy diurnally active persons (but not abnormal sleep-time non-dipper or riser types: see Smolensky et al., 2017).”
BackgroundInfluentialSelf-citationAkhtar, N., Al-Jerdi, S., Kamran, S., Singh, R., Babu, B. M., Abdelmoneim, M. S., Morgan, D., Joseph, S., Francis, R., & Shuaib, A. M. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.719311 · Cited by 15 · see citing works
“A similar methodology has been used in previous studies (2).”
BackgroundMethodInfluentialHaghayegh, S., Smolensky, M. H., Khoshnevis, S., Hermida, R. C., Castriotta, R. J., & Diller, K. R. (2021) · Comprehensive physiology · doi:10.1002/cphy.c210008 · Cited by 16 · see citing works
Self-citationCircadian rhythm disruptions: A possible link of bipolar disorder and endocrine comorbidities
Xiu, Y., Xu, P., & Sun, X. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1065754 · Cited by 14 · see citing works
Chai, R., Ye, Z., Wu, Q., Xue, W., Shi, S., Du, Y., Wu, H., Yi, W., & Hu, Y. (2023) · European journal of medical research · doi:10.1186/s40001-023-01158-8 · Cited by 14 · see citing works
“In addition, the circadian rhythm is recognized to affect several cardiovascular events, including endothelial function [21–23], thrombus formation [24, 25], blood pressure [26, 27], and heart rate [28].”
BackgroundRowland, S. N., James, L. J., O’Donnell, E., & Bailey, S. J. (2023) · European Journal of Applied Physiology · doi:10.1007/s00421-023-05369-z · Cited by 15 · see citing works
“The factors that regulate BP across the day are multifaceted (including but not limited to renal haemo-dynamics, the nervous system and mental/emotional stress) and highly complex (Smolensky et al. 2017), and as such it is unclear why reductions in brachial BP were not observed in the present study.”
BackgroundEvening versus morning dosing regimen drug therapy for hypertension
Wu, C., Zhao, P., Xu, P., Wan, C., Singh, S., Varthya, S. B., & Luo, S. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004184.pub3 · Cited by 14 · see citing works
Association Between Na, K, and Lipid Intake in Each Meal and Blood Pressure
Imamura, M., Sasaki, H., Shinto, T., Tahara, Y., Makino, S., Kuwahara, M., Tada, A., Abe, N., Michie, M., & Shibata, S. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.853118 · Cited by 14 · see citing works
Ellingson, C. J., Singh, J., Ellingson, C. A., Dech, R. T., Piskorski, J., & Neary, J. P. (2022) · Current Research in Physiology · doi:10.1016/j.crphys.2022.06.003 · Cited by 15 · see citing works
Microsurgical Performance After Sleep Interruption: A NeuroTouch Simulator Study
Micko, A. S. G., Knopp, K., Knosp, E., & Wolfsberger, S. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.06.142 · Cited by 14 · see citing works
Hermida, R. C., Hermida‐Ayala, R. G., Mojón, A., Smolensky, M. H., & Fernández, J. R. (2021) · Chronobiology International · doi:10.1080/07420528.2021.1931280 · Cited by 14 · see citing works
“…circadian mechanisms of BP regulation is linked to the state or specific stages of sleep, especially those of the RAAS and ANS (associated with rapid eyeball movement) (Smolensky et al. 2017) that coincide in time with the greatest cardiac remodeling (Martino et al. 2011; Sole and Martino 2009).”
BackgroundInfluentialSelf-citationSleep and Circadian Regulation of the Autonomic Nervous System
de Zambotti, M., & Baker, F. C. (2021) · Springer eBooks · doi:10.1007/978-3-030-62263-3_7 · Cited by 13 · see citing works
Cortés‐Ríos, J., Hermida, R. C., & Rodriguez-Fernández, M. (2022) · PLoS Computational Biology · doi:10.1371/journal.pcbi.1010711 · Cited by 13 · see citing works
Self-citationCortés‐Ríos, J., & Rodriguez-Fernández, M. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1110459 · Cited by 13 · see citing works
“On the other hand, pharmacodynamic changes are due to circadian changes in physiological regulation mechanisms of BP, such as components of the renin-angiotensin-aldosterone system, norepinephrine, epinephrine, Na+ transporters, among others (13, 14), and changes in variables related to routine, such as physical activ…”
BackgroundWang, X., Liu, T., Lv, X., Sun, N., Li, F., Luo, L., Zhuge, X., Huang, J., & Wang, L. (2023) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00047-23 · Cited by 13 · see citing works
Fernández, J. R., Mojón, A., & Hermida, R. C. (2020) · Chronobiology International · doi:10.1080/07420528.2020.1771355 · Cited by 13 · see citing works
Self-citationHermida, R. C., Mojón, A., & Fernández, J. R. (2020) · Chronobiology International · doi:10.1080/07420528.2020.1771354 · Cited by 13 · see citing works
Self-citationCircadian rhythm disorder: a potential inducer of vascular calcification?
Huang, H., Li, Z., Ruan, Y., Feng, W., Chen, J., Li, X., Ouyang, L., & Huang, H. (2020) · Journal of Physiology and Biochemistry · doi:10.1007/s13105-020-00767-9 · Cited by 13 · see citing works
Hermida, R. C., Mojón, A., Smolensky, M. H., & Fernández, J. R. (2021) · Hypertension · doi:10.1161/hypertensionaha.120.16500 · Cited by 13 · see citing works
Self-citationPreclinical evaluation of circadian rhythm in ischemic stroke outcomes.
Kamat, P. K., Khan, M. B., Wood, K., Siddiqui, S., Rudic, R. D., Dhandapani, K. M., Waller, J. L., & Hess, D. C. (2021) · PubMed · Cited by 13 · see citing works
Sleep and Cardiovascular Health
Pinilla, L., Pumarega, I. C., & Sánchez‐de‐la‐Torre, M. (2025) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/a-2591-5462 · Cited by 13 · see citing works
“15 – 17 The autonomic nervous system plays a pivotal role in orchestrating cardiovascular functions during sleep.”
Karlamangla, A. S., Almeida, D. M., Lachman, M. E., Merkin, S. S., Thomas, D., & Seeman, T. E. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105804 · Cited by 13 · see citing works
Chrono‐nutrition for hypertension
Bohmke, N. J., Dixon, D. L., & Kirkman, D. L. (2024) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3760 · Cited by 15 · see citing works
“39 In addition, inappropriate regulation of renal sodium transporters and channels by the circadian clock also results in abnormal sodium handling and BP 47,48 (Figure 3).”
BackgroundJamal, N. E., Brooks, T. G., Cohen, J. B., Townsend, R. R., Sosa, N., Shah, V. O., Nelson, R. G., Drawz, P. E., Rao, P. S., Bhat, Z. Y., et al. (2024) · Journal of Human Hypertension · doi:10.1038/s41371-023-00884-0 · Cited by 12 · see citing works
“This was neither seen in 24 h blood pressure control (17.20 [13.07 – 22.63] per 1000 person years in uncontrolled BP, 9.85 [5.83 – 22.63] per 1000 person years in controlled BP, p = 057) nor in dipping category (16.11 [12.03 – 21.58] per 1000 person years in non-dippers, 12.55 [8.10 – 19.45] per…”
BackgroundInfluentialBommarito, J. C., & Millar, P. J. (2023) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00441.2023 · Cited by 13 · see citing works
Kooman, J. P., Usvyat, L. A., Dekker, M. J. E., Maddux, D. W., Raimann, J. G., SANDE, F. M. V. D., Ye, X., Wang, Y., & Kotanko, P. (2018) · Blood Purification · doi:10.1159/000494827 · Cited by 12 · see citing works
Ellingson, C. J., Shafiq, M. A., Ellingson, C. A., Neary, J. P., Dehghani, P., & Singh, J. (2024) · Autonomic Neuroscience · doi:10.1016/j.autneu.2024.103160 · Cited by 12 · see citing works
“Furthermore, the ANS exhibits rhythmic circadian changes throughout the day (Smolensky et al., 2017), highlighting the importance of conducting subsequent assessments at the same time of day.”
Background
- Authors
- Smolensky, M. H., Hermida, R. C., & Portaluppi, F.
- Affiliations
- The University of Texas at Austin (US)
- Universidade de Vigo (ES)
- University of Ferrara (IT)
- Corresponding author
- Smolensky, Michael H.
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 33
- Pages
- 4-16
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2290785732
- Cited by
- 237
- References
- 221
- Citations by year
- 2026: 18 · 2025: 20 · 2024: 33 · 2023: 33 · 2022: 36 · 2021: 32 · 2020: 24 · 2019: 11 · 2018: 12 · 2017: 12 · 2016: 6
- FWCI
- 2.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- circadian rhythm, blood pressure regulation, secondary hypertension, melatonin, renin-angiotensin-aldosterone system, hypothalamic-pituitary-adrenal axis, renal hemodynamics, vasoactive peptides, opioid system, hypertension control
- MeSH terms
- Antihypertensive Agents, Autonomic Nervous System, Blood Pressure, Circadian Rhythm, Humans, Hypertension, Renin-Angiotensin System, Sleep, Time Factors, Blood Pressure Monitoring, Ambulatory
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