Diurnal Blood Pressure Variations Are Associated with Changes in Distal–Proximal Skin Temperature Gradient

Abstract

It is generally assumed that skin vascular resistance contributes only to a small extent to total peripheral resistance and hence to blood pressure (BP). However, little is known about the impact of skin blood flow (SBF) changes on the diurnal variations of BP under ambulatory conditions. The main aim of the study was to determine whether diurnal patterns of distal SBF are related to mean arterial BP (MAP). Twenty-four-hour ambulatory measurements of BP, heart rate (HR) and distal (mean of hands and feet) as well as proximal (mean of sternum and infraclavicular region) skin temperatures were carried out in 51 patients (men/women = 18/33) during a 2-d eye hospital investigation. The standardized ambulatory protocol allowed measurements with minimal interference from uncontrolled parameters and, hence, some conclusive interpretations. The distal minus proximal skin temperature gradient (DPG) provided a measure for distal SBF. Individual cross-correlation analyses revealed that the diurnal pattern of MAP was nearly a mirror image of DPG and hence of distal SBF. Scheduled lunch and dinner induced an increase in DPG and a decline in MAP, while HR increased. Low daytime DPG (i.e. low distal SBF) levels significantly predicted sleep-induced BP dipping (r = −.436, p = .0014). Preliminary path analysis suggested that outdoor air temperature and atmospheric pressure may act on MAP via changed distal SBF. Changes in distal SBF may contribute to diurnal variation in MAP, including sleep-induced BP dipping and changes related to food intake. This finding might have an impact on individual cardiovascular risk prediction with respect to diurnal, seasonal and weather variations; however, the underlying mechanisms remain to be discovered.

Keywords:

• Blood pressure
• Diurnal variation
• Distal skin blood flow
• Heart rate
• Skin temperatures

ACKNOWLEDGMENTS

The authors would like to acknowledge the patients who volunteered for these studies and the nurses of the University Eye Clinic of Basel who made this study possible. We are very grateful to Prof. Roberto Amici (Bologna) and Dr Sarah Chellappa (Basel) for their helpful comments to the manuscript in a former version and Dr Roland Vogt (Institute of Meteorology, University of Basel) for providing the meteorological data.

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Sources of Funding: Schwickert-Stiftung and Swiss National Science Foundation #32003B-116504/1.