The Relation Between Blood Pressure Variation and Daily Physical Activity in Early Morning Surge in Blood Pressure.

Suzuki, Yasuko; Kuwajima, Iwao; Mitani, Kenichi; Miyao, Mariko; Uno, Ayako; Matsushita, Satoru; Kuramoto, Kizuku

doi:10.3143/geriatrics.30.841

Cited by 23 publications

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“…Normal daily activities were allowed and encouraged, and subjects were told to keep their nondominant arm still and relaxed at their side during measurements. To abide by the actual wakefulness-sleep rhythm reported in subjects' diaries, we defined daytime as between10:00 AM and 10:00 PM and nighttime as between 1:00 AM and 6:00 AM The morning BP peak was defined as a rise in systolic BP Ն50 mm Hg (90% percentile of normotensive patients) 17 and/or diastolic BP Ն22 mm Hg 18 during the early morning (6:00 to 10:00 AM), arbitrarily defined as the morning period, compared with the mean BP during the night. Subjects without a morning BP peak were defined as the MPϪ group and the others as the MPϩ group.…”

Section: Methodsmentioning

confidence: 99%

Morning Blood Pressure Peak, QT Intervals, and Sympathetic Activity in Hypertensive Patients

et al. 2003

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Abstract-We investigated the relation between morning blood pressure (BP) variations, sympathetic activity, and QT intervals in 156 never-treated subjects with essential hypertension and different patterns of morning BP increase. The morning BP peak (MP) was defined as a rise in systolic BP Ն50 mm Hg and/or diastolic BP Ն22 mm Hg during early morning (6:00 to 10:00 AM) compared with mean BP during the night. Clinical characteristics of patients with morning BP peak (MPϩ, nϭ 69, morning systolic BPϭϩ54Ϯ4, diastolic BPϭϩ32Ϯ5 mm Hg) did not differ from patients without BP peak (MPϪ, nϭ 87, morning systolic BPϭϩ24Ϯ5, diastolic BPϭϩ19Ϯ3 mm Hg). The daytime (10:00 AM to 10:00 PM) and the nighttime (10:00 PM to 6:00 AM) BP profile did not differ between the two groups. During daytime and nighttime ECG monitoring, the corrected QT (QTc) interval, and QTc dispersion did not differ significantly between the two groups, whereas during the morning period the QT values were significantly broader in the MPϩ group compared with the MPϪ group (PՅ0.001). Morning LF/HF ratio was significantly higher in MPϩ patients than in MPϪ patients (PՅ0.02). Both systolic and diastolic morning BP, in combination with ratio LF/HF power, were significant predictors of QTc dispersion (adjusted R 2 ϭ0.59, PՅ0.01) and QTc interval (adjusted R 2 ϭ0.41, PՅ0.01), whereas inclusion of physical activity and echocardiographic parameters did not add explanatory information. The prolongation of cardiac repolarization times and morning sympathetic overactivity coexist in hypertensive patients with morning BP peaks, and they might contribute to raised cardiovascular risk in these patients. Key Words: hypertension, essential Ⅲ blood pressure Ⅲ sympathetic nervous system M any studies in the past decade have demonstrated diurnal variation in the onset of acute cardiovascular disorders in hypertensive patients, such as myocardial ischemia, 1 acute myocardial infarction, 2 cardiac arrhythmias, 3 and sudden cardiac death. 4 The results consistently have showed an increased incidence of acute cardiac events in the morning hours (between 6 AM and noon) and a low incidence at night. Blood pressure (BP) falls markedly during the night because of the reduction of sympathetic activity (and the increase in vagal drive) 5 that is brought about by sleep and then increases steeply when in the morning the subject awakes and resumes his or her daily activities. 6 This increase occurs together with a peak incidence of myocardial infarction, sudden death, and cardiac arrhythmias in the morning hours. 7 However, the mechanisms underlying this association are not clear. According to many studies, 8,9 ventricular arrhythmias are more frequent in hypertensive individuals compared with normotensive individuals, and this frequency is particularly high in those with morning BP peak. Furthermore, several other phenomena potentially dangerous for the heart, such as heart rate, fibrinolytic activity, platelet aggregability, and circulating catecholamines, also show peak adverse modific...

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Section: Methodsmentioning

confidence: 99%

Morning Blood Pressure Peak, QT Intervals, and Sympathetic Activity in Hypertensive Patients

et al. 2003

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“…This is the likely explanation of why intra-arterial data for a large group of normal subjects, aligned relative to the time of waking, show that the early morning rise of BP commences prior to awakening; thus, its attribution to arousal alone seems highly implausible. Wrist actigraphy, a tool commonly used in sleep studies, has helped identify two distinct patterns of morning BP rise -one being defined by a gradual rise that commences before awakening as seen most commonly in young persons, and the other being defined by a steep BP rise that commences after waking as seen most commonly in elderly persons showing pronounced responses to mental stress [85]. A growing number of studies indicate that the extent of the BP rate of rise coincident with the commencement of diurnal activity constitutes an independent predictor of hypertensive target organ damage and risk of acute CV events at this time of day [9,86].…”

Section: Role Of Sleep In Circadian Bp Variationmentioning

confidence: 99%

Role of sleep-wake cycle on blood pressure circadian rhythms and hypertension

et al. 2007

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“…However, in the rat there is evidence that cardiovascular rhythms are controlled by the central clock(s) located in the suprachiasmatic nuclei (SCN) of the hypothalamus, since the rhythms persist under free-run conditions (i.e., in the absence of environmental time cues such as the periodic ambient light-dark cycle) and are abolished by lesioning of the SCN [3,51]. Some investigators suggest the existence of two different patterns in BP: one that begins to gradually rise before awakening, which is thought to be especially common in younger persons, and another that starts to rise with physical activity, which seems to be especially common in the elderly [52,53]. In any case, the morning surge in HR and BP results in a markedly increased (by as much as 40%) myocardial oxygen demand at this time of the day [54].…”

Section: Temporal Changes In the Pathophysiological Mechanisms Of Ihdmentioning

confidence: 99%

Chronobiology and chronotherapy of ischemic heart disease

Portaluppi

2007

Advanced Drug Delivery Reviews

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The Relation Between Blood Pressure Variation and Daily Physical Activity in Early Morning Surge in Blood Pressure.

Cited by 23 publications

References 0 publications

Morning Blood Pressure Peak, QT Intervals, and Sympathetic Activity in Hypertensive Patients

Morning Blood Pressure Peak, QT Intervals, and Sympathetic Activity in Hypertensive Patients

Role of sleep-wake cycle on blood pressure circadian rhythms and hypertension

Chronobiology and chronotherapy of ischemic heart disease

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