Dipper and Non-Dipper Blood Pressure 24-Hour Patterns: Circadian Rhythm–Dependent Physiologic and Pathophysiologic Mechanisms
Abstract
Neuroendocrine mechanisms are major determinants of the normal 24-h blood pressure (BP) pattern. At the central level, integration of the major driving factors of this temporal variability is mediated by circadian rhythms of monoaminergic systems in conjunction with those of the hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, opioid, renin-angiotensin-aldosterone, plus endothelial systems and specific vasoactive peptides. Humoral secretions are typically episodic, coupled either to sleep and/or the circadian endogenous (suprachiasmatic nucleus) central pacemaker clock, but exhibiting also weekly, monthly, seasonal, and annual periodicities. Sleep induction and arousal are influenced also by many hormones and chemical substances that exhibit 24-h variation, e.g., arginine vasopressin, vasoactive intestinal peptide, melatonin, somatotropin, insulin, steroids, serotonin, corticotropin-releasing factor, adrenocorticotropic hormone, thyrotropin-releasing hormone, endogenous opioids, and prostaglandin E2, all with established effects on the cardiovascular system. As a consequence, physical, mental, and pathologic stimuli that activate or inhibit neuroendocrine effectors of biological rhythmicity may also interfere with, or modify, the temporal BP structure. Moreover, immediate adjustment to exogenous components/environment demands by BP rhythms is modulated by the circadian-time-dependent responsiveness of biological oscillators and their neuroendocrine effectors. This knowledge contributes to a better understanding of the pathophysiology of abnormalities of the 24-h BP pattern and level and their correction through circadian rhythm-based chronotherapeutic strategies.
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In most healthy subjects, there is diurnal variation in blood pressure that parallels the circadian variation of blood pressure regulating systems such as sympathetic activity, cortisol and aldosterone.
“In most healthy subjects, there is diurnal variation in blood pressure with systolic and diastolic blood pressures which parallels, in general, the circadian variation of blood pressure regulating systems such as sympathetic activity, cortisol and aldosterone 62.”
From The Circadian Syndrome: is the Metabolic Syndrome and much more! (2019) · cites this paper as [62]
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Self-citationPortaluppi, F., Montanari, L., Vergnani, L., Tarroni, G., Cavallini, A. R., Gilli, P., Bagni, B., & Uberti, E. C. D. (2008) · Cardiology · doi:10.1159/000175020 · Cited by 19 · see citing works
Self-citationKachi, T., Banerji, T. K., & Quay, W. B. (1984) · Journal of Pineal Research · doi:10.1111/j.1600-079x.1984.tb00193.x · Cited by 19 · see citing works
Uberti, E. C. D., Ambrosio, M. R., Vergnani, L., Portaluppi, F., Bondanelli, M., Trasforini, G., Margutti, A., & Salvadori, S. (1993) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.77.6.8263131 · Cited by 19 · see citing works
Self-citationChronobiology of the Hypothalamic-Pituitary-Thyroid Axis
Nicolau, G. Y., & Haus, E. L. (1992) · Springer eBooks · doi:10.1007/978-3-642-78734-8_24 · Cited by 18 · see citing works
Sander, D., & Klingelhöfer, J. (1993) · Clinical Neurology and Neurosurgery · doi:10.1016/0303-8467(93)90127-3 · Cited by 18 · see citing works
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The Circadian Syndrome: is the Metabolic Syndrome and much more!
Zimmet, P., Alberti, K. G. M. M., Stern, N., Bilu, C., El‐Osta, A., Einat, H., & Kronfeld‐Schor, N. (2019) · Journal of Internal Medicine · doi:10.1111/joim.12924 · Cited by 387 · see citing works
Circadian mechanisms of 24-hour blood pressure regulation and patterning
Smolensky, M. H., Hermida, R. C., & Portaluppi, F. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.02.003 · Cited by 237 · see citing works
Self-citationSmolensky, 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
Self-citationStuebner, E., Vichayanrat, E., Low, D. A., Mathias, C. J., Isenmann, S., & Haensch, C.-A. (2013) · Frontiers in Neurology · doi:10.3389/fneur.2013.00049 · Cited by 84 · see citing works
- Authors
- Fabbian, F., Smolensky, M. H., Tiseo, R., Pala, M., Manfredini, R., & Portaluppi, F.
- Affiliations
- University of Ferrara (IT)
- The University of Texas at Austin (US)
- Corresponding author
- Portaluppi, Francesco
- Venue
- Chronobiology International
- Publisher
- Informa UK Limited
- Published
- 2012-09-24
- Volume
- 30
- Issue
- 1-2
- Pages
- 17-30
- ISSN
- 0742-0528 (ISSN-L)
- 1525-6073
- OpenAlex
- W1992744537
- Cited by
- 147
- References
- 225
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 7 · 2023: 11 · 2022: 5 · 2021: 18 · 2020: 14 · 2019: 7 · 2018: 10 · 2017: 10 · 2016: 12 · 2015: 17 · 2014: 11 · 2013: 10 · 2012: 4
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Chronobiology International (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- non-dipping blood pressure, circadian rhythm, neuroendocrine regulation, monoaminergic systems, hypothalamic-pituitary-adrenal axis, renin-angiotensin-aldosterone system, vasoactive peptides, suprachiasmatic nucleus, chronotherapy, hypertension pathophysiology
- MeSH terms
- Adrenal Glands, Analgesics, Opioid, Animals, Autonomic Nervous System, Blood Pressure, Cardiovascular Diseases, Circadian Rhythm, Humans, Hypothalamus, Kidney, Pituitary Gland, Renin-Angiotensin System, Seasons, Sleep, Thyroid Gland, Time Factors, Blood Pressure Monitoring, Ambulatory
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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