Circadian Blood Pressure Rhythm in Cardiovascular and Renal Health and Disease

Blood pressure (BP) follows a circadian rhythm, it increases on waking in the morning and decreases during sleeping at night. Disruption of the circadian BP rhythm has been reported to be associated with worsened cardiovascular and renal outcomes, however the underlying molecular mechanisms are still not clear. In this review, we briefly summarized the current understanding of the circadian BP regulation and provided therapeutic overview of the relationship between circadian BP rhythm and cardiovascular and renal health and disease.

The Relationship between Abnormal Circadian Blood Pressure Rhythm and Risk of Readmission in Patients with Heart Failure with Preserved Ejection Fraction

Objective: Abnormal circadian blood pressure rhythm has been revealed to be associated with hypertensive targetorgan damage and cardiovascular events, but its association with readmission risk in patients with heart failure with preserved ejection fraction (HFpEF) remains unknown. We conducted a retrospective study to explore the relationship between circadian blood pressure rhythm and readmission risk in HFpEF patients.Methods: We retrospectively collected baseline and follow-up data on HFpEF patients who underwent ambulatory blood pressure monitoring (ABPM) from May 2015 to October 2019. Patient circadian blood pressure rhythms defined by ABPM were grouped as dipper, nondipper, or riser patterns. Univariate and multivariate linear regression analyses were performed to assess the association between circadian blood pressure rhythm and readmission risk.Results: A total of 122 patients were enrolled in this study. The mean age and ejection fraction were 69.87 years and61.44%, respectively, with mean the N-terminal pro-B-type natriuretic peptide (NT-proBNP) level being 1048.15 pg/mL.There were significant differences in the 24-hour systolic blood pressure (SBP), sleep SBP, and sleep diastolic blood pressure (DBP) among the three groups, where the 24-hour SBP, sleep SBP, and sleep DBP in the riser pattern group were markedly higher than in the dipper pattern group. Notably, serum NT-proBNP levels, the proportion of patients readmitted for heart failure and the mean number of admissions differed markedly among three groups. Instructively, multivariate linear regression analysis showed that the riser pattern was a significant and independent risk factor for increased serum NT-proBNP level (β = 929.16, 95% confidence interval 178.79–1679.53, P = 0.016). In multivariatelogistic regression analysis, the riser pattern was demonstrated to be a significant risk factor for readmission (odds ratio11.23, 95% confidence interval 2.01–62.67, P = 0.006) in HFpEF patients.Conclusion: The riser blood pressure pattern is a potential risk factor for elevated serum NT-proBNP level and readmissionin HFpEF patients.

CIRCADIAN PROFILE OF VASCULAR TONE AS A BASE FOR THE CIRCADIAN RHYTHM OF BLOOD PRESSURE IN CHILDREN

The review is about modern conceptions of vascular tone regulation and its influence on circadian blood pressure rhythm.