Tohoku J. Exp. Med., 1997, 183 (1)

Determinants of Circadian Blood Pressure Variation: A Community-Based Study in Ohasama

AKIMITSU NISHIYAMA, YUTAKA IMAI, TAKAYOSHI OHKUBO,1 ICHIRO TSUJI,1 KENICHI NAGAI,3 NORIKO KIKUCHI, JUNKO KATO, MAKOTO SEKINO, AKIKO AIHARA, MASAHIRO KIKUYA, HIROSHI SATOH2 and SHIGERU HISAMICHI1

The Second Department of Medicine, 1Department of Public Health and 2Department of Environmental Health Science, Tohoku University School of Medicine, Sendai 980-77, and 3 Ohasama Hospital, Iwate 028-32

  • We investigated facters affecting the nocturnal decline in blood pressure (BP). A cross sectional study was done in 706 community-based untreated subjects >=20 years of age. Screening and ambulatory BPs were measured and the effects of age and the ambulatory BP on the nocturnal decline were examined. Bivariate analysis demonstrated that the magnitude of the decline and the percent decline in the nocturnal BP increased with increase in daytime ambulatory BP and decreased with increase in nighttime ambulatory BP. Although the magnitude of the nocturnal decline in BP increased with increasing daytime BP, the nocturnal BP in hypertensives was still higher than those in normotensives. The magnitude decreased with increasing age in men but not in women, while the percent decline decreased with increasing age in both men and women. Since bivariate analysis demonstrated that the daytime BP, nighttime BP, and standard deviation of the 24-hour B P strongly correlated with the magnitude of the nocturnal decline, these parameters were excluded as independent variables from the multivariate analysis. In the multivariate analysis the nighttime pulse pressure was negatively and daytime pulse pressure was positively associated with the magnitude of the decline and the percent decline in the nocturnal BP. A non-dipping circadian variation was frequently observed in elderly normotensive men but the rate of nondipper was rather low in hypertensive individuals in the general population. A marked dipping pattern was frequently observed in hypertensive women >=70 years of age. The nocturnal BP levels in subjects with daytime hypertension are higher than those in subjects with daytime normotension. Therefore, BP must ideally be lowered over 24-hour period in hypertensive subjects. The diminished magnitude of the decline and the decrease in the percent decline in the nocturnal BP in the elderly may be mediated by the disturbed baroreflex function due to the decrease in compliance of large elastic artery. However, in some elderly hypertensive women, excess nocturnal decline in BP is observed. In such subjects, we should take care of the nocturnal BP levels during treatment.
    Key words--- ambulatory monitoring; blood pressure; nocturnal decline; dipper; non-dipper
    © 1997 Tohoku University Medical Press

    Tohoku J. Exp. Med., 1997, 183, 1-20
    Address for reprints: Dr. Yutaka Imai, The Second Department of Medicine, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai 981-77, Japan.

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