Cited by 237Blood Pressure and Hypertension StudiesCircadian rhythm and melatoninHeart Rate Variability and Autonomic Control

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Circadian mechanisms of 24-hour blood pressure regulation and patterning

Smolensky, Michael H., Hermida, Ramón C., Portaluppi, Francesco·2017·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2016.02.003

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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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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.
ORCID: Smolensky, Michael H.
Hermida, Ramón C.
Portaluppi, Francesco
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2017-06
Volume: 33
Pages: 4-16
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2016.02.003
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
FWCI: 2.42
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Circadian mechanisms of 24-hour blood pressure regulation and patterning

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