The importance of sleep blood pressure

Abstract

Blood pressure (BP) varies throughout the day owing to interactions between the sympathetic nervous and the renin–angiotensin systems. When awake BP is controlled by sympathetic nervous system activity but during sleep the renin–angiotensin system becomes more important. The lower BP during sleep is a more powerful predictor of outcome than the awake BP. Certain individuals do not have the fall in BP with sleep and this worsens the outcome. Inadequate handling of sodium by the kidney is an important factor preventing this BP fall. The different drug classes have varying effects on BP during 24 h. Drugs that act independently of the two controlling systems have a similar effect at day and night. Drugs that act on the sympathetic nervous system have a greater effect during the day and little effect during sleep unless the sympathetic system is still active. Drugs that act via the renin–angiotensin system have a greater effect during sleep. Controlling BP during sleep may improve outcome.

Keywords::

• cardiac hypertrophy
• dippers
• myocardial infarction
• nondippers
• renin–angiotensin system
• sleep blood pressure
• stroke
• sympathetic nervous system

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

BP: Blood pressure.