The DOI matches its Crossref record; 216 of the 221 references it cites were found in a registry or an index.
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 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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“In contrast, nondipper or reverse-dipper patterns are associated with a sustained predominance of sympathetic activity (Williams et al., 2018; Smolensky et al., 2017).”
López-Coleto, L., García‐Arcos, A., González‐Martín, F., Hermosilla‐Lloris, E., Piedras‐Montilla, F., Durán‐Luengo, A. M., García, L. S., Vico, A. D., Jaraba‐Caballero, S., Morales‐Cané, I., et al. (2026) · Nursing in Critical Care · doi:10.1111/nicc.70625
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“…circadian processes shift cardiovascular targets predictively, preparing the body for anticipated demands before they arise (Clow et al., 2010; Smolensky et al., 2017); fever represents adaptive set-point elevation driven by immune-brain signaling, in which Tier 2 machinery defends an…”
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Metadata
- 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
- 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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