Diurnal Blood Pressure Rhythmicity in Relation to Environmental and Genetic Cues in Untreated Referred Patients.
No previous study has addressed the relative contributions of environmental and genetic cues to the diurnal blood pressure rhythmicity. From 24-hour ambulatory recordings of systolic blood pressure obtained in untreated patients (51% women; mean age, 51 years), we computed the night-to-day ratio in 897 and morning surge in 637. Environmental cues included season, mean daily outdoor temperature, atmospheric pressure, humidity and weekday, and the genetic cues 14 single nucleotide polymorphisms in 10 clock genes. Systolic blood pressure averaged (±SD) 126.7±11.9 mm Hg, night-to-day ratio 0.86±0.07, and morning surge 24.8±10.7 mm Hg. In adjusted analyses, night-to-day ratio was 2.4% higher in summer and 1.8% lower in winter (P<0.001) compared with the annual average with a small effect of temperature (P=0.079); morning surge was 1.7 mm Hg lower in summer and 1.1 mm Hg higher in winter (P<0.001). The other environmental cues did not add to the night-to-day ratio or morning surge variance (P≥0.37). Among the 14 genetic variations, only CLOCK rs180260 was significantly associated with morning surge after adjustment for season, temperature, and other host factors and after Bonferroni correction (P=0.044). In CLOCK rs1801260 C allele carriers (n=83), morning surge was 3.7 mm Hg higher than in TT homozygotes (n=554). Of the night-to-day ratio and morning surge variance, season and temperature explained ≈8% and ≈3%, while for genetic cues, these proportions were ≈1% or less. In conclusion, environmental compared with genetic cues are substantially stronger drivers of the diurnal blood pressure rhythmicity.
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Chang-Sheng
CS
Sheng
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Yi-Bang
YB
Cheng
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Fang-Fei
FF
Wei
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Wen-Yi
WY
Yang
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Qian-Hui
QH
Guo
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Fei-Ka
FK
Li
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Qi-Fang
QF
Huang
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Lutgarde
L
Thijs
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Jan A
JA
Staessen
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.).
Ji-Guang
JG
Wang
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L.T., J.A.S.); and R & D Group VitaK, Maastricht University, The Netherlands (J.A.S.). liyanshcn@yahoo.com.
Yan
Y
Li
D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002681:China / Q000453:epidemiology; D002940:Circadian Rhythm / Q000502:physiology; D003463:Cues; D004781:Environmental Exposure; D005260:Female; D005500:Follow-Up Studies; D005819:Genetic Markers; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors
D005819:Genetic Markers
ambient temperature; blood pressure measurement; blood pressure variability; clock genes; season