Abstract
Blood pressure (BP) varies according to many internal and external factors, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies throughout the day and night. These changes in BP are closely related to mental and physical activities, and the sympathetic nervous system mainly contributes to the diurnal variation in BP. Other behavioral factors, such as food consumption and obesity, dietary intake of sodium, drinking and smoking habits, consumption of coffee and tea, and bathing, also affect the diurnal variation in BP. Alterations in diurnal BP variation due to behavioral factors are frequently seen in patients with hypertension and can be classified as morning hypertension, daytime hypertension and nighttime hypertension. Appropriate lifestyle modifications may normalize or improve both the level and rhythm of BP in these patients.
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Introduction
Blood pressure (BP) varies according to many internal and external factors. There are several distinctive rhythmic variations in BP including diurnal (or circadian) variation, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies with changes in mental and physical activities during daytime and nighttime.1, 2, 3, 4 In addition to the awake and sleep cycle, many behavioral factors, such as mental stress, exercise, food consumption, changes in body weight, dietary intake of sodium and other electrolytes, drinking and smoking habits, consumption of coffee and tea, and bathing, influence both the level and variation in BP.5, 6, 7, 8
Understanding the influences of those behavioral factors on diurnal BP variation is important for the management of hypertension because alterations in diurnal BP variation due to behavioral factors are observed in many hypertensive subjects.9, 10 It has been shown that ambulatory BP monitoring is useful for assessing the influence of behavioral factors as well as the effects of lifestyle modifications on the level and pattern of BP throughout the day.11, 12 In this review article, I would like to summarize the effects of behavioral factors on diurnal BP variation with respect to the pathophysiology of hypertension and the effects of lifestyle modifications on 24-h BP.
Diurnal BP variation in relation to mental and physical activity
Awake and sleep cycle
Diurnal variation in BP is well recognized. Usually, BP rapidly rises on wakening in the early morning, reaches a plateau during the morning, falls slightly in the early afternoon and rises again in the early evening.1, 2 BP decreases gradually in the late evening, drops sharply after falling asleep and is lowest during sleep. These changes in BP are largely attributed to mental and physical activities, and the sympathetic nervous system has a crucial role in the generation of diurnal BP variation.9, 13, 14, 15 It has been shown that diurnal changes in BP coincide with changes in heart rate and the levels of plasma and urinary catecholamines.13, 14, 15, 16 It also has been shown that BP is high during nighttime working hours and low during daytime sleeping hours in shift workers, although the dip in BP during sleeping hours may be attenuated at the beginning of the night shift.17, 18 These results indicate that the endogenous clock has a minor role in the generation of BP variation associated with the awake and sleep cycle.
The morning rise in BP mainly depends on physical activity after waking. It has been shown that BP changes little after waking when the subjects remain supine, but rises rapidly when they get out of bed.19 It is also reported that the magnitude of the morning rise in BP is correlated with changes in physical activity.20 Although the morning rise in BP is a physiological phenomenon, some hypertensive patients show an exaggerated rise in BP that is called the morning surge. Cardiovascular events such as myocardial infarction and stroke occur most frequently in the early morning, and the morning surge in BP appears to have an important role in the onset of these cardiovascular events.3, 21, 22 On the other hand, the nighttime dip in BP is also altered in many hypertensive patients. A number of studies have shown that nondipping of the nighttime BP is associated with target organ damage and cardiovascular disease in hypertensive patients.23, 24
Mental and physical stress
As the variation in BP is closely associated with mental and physical activities, mental and physical stress causes not only acute changes in BP but also modifies diurnal BP variation. The morning rise in BP mainly depends on physical activity; however, mental and physical stress associated with housework and going to work in the early morning may cause an exaggerated BP surge and morning hypertension (Table 1).25 Many hypertensive patients experience a higher morning BP at home on weekdays compared with the weekend. In a study using repeated ambulatory BP monitoring, the morning surge in BP was largest on Monday among a community dwelling population.26
Mental and physical stress elevates BP during the daytime and may cause daytime hypertension (Table 1).25 It has been shown that job stress is related to higher BP at work in normotensive subjects.5, 27 Another study showed that the BP response to daily stress was enhanced in hypertensive subjects compared with normotensive subjects.28 Ambulatory BP during work was 10% higher than home BP in hypertensives, but the difference was only 3% in normotensives in this study. It was also reported that more than 20% of civil servants showed worksite hypertension, although they were found to be normotensive during a health examination.29
Stress in daily life may be relieved by hospitalization. In our study, hospitalization tended to lower daytime BP and diminished the day–night BP difference in hypertensive patients (Table 2).30 It should be mentioned that many patients were dippers during the outpatient period but became nondippers after admission. Regarding the effect of stress management, it has been shown that transcendental and contemplative meditation effectively lowered ambulatory BP in clinical trials.31, 32
Mental and physical activities also affect nighttime BP. A study using beat-to-beat BP and electroencephalographic measurements revealed that frequent cuff inflation during ambulatory BP monitoring caused arousal from sleep and elevated BP.33 In another study using sleep actigraphy, nondippers showed higher activity levels and spent less time asleep when in bed compared with dippers.34 Therefore, sleep disturbance elevates BP and may contribute to the nondipping of BP at night.
Exercise
BP rises during exercise but falls after exercise. This exercise-induced BP elevation is due to an increase in cardiac output, and its magnitude depends on the intensity of exercise. Postexercise hypotension is associated with a decrease in total peripheral resistance and persists for several hours.35 These exercise related changes in BP affect diurnal BP variation.
A sedentary lifestyle is a risk factor for hypertension, and guidelines recommend regular exercise for the management of hypertension. A number of intervention studies have demonstrated the BP-lowering effect of exercise.36 Several studies have also shown that regular exercise lowers ambulatory BP in normotensive and hypertensive subjects. Miyai et al.37 reported that bicycle exercise reduced daytime BP and attenuated BP elevation during exercise without changing nighttime BP in normotensive subjects. Park et al.38 studied the effect of time of day on the influence of exercise in hypertensive patients. In their study, morning exercise decreased daytime BP in both dippers and nondippers, whereas evening exercise lowered nighttime BP in nondippers but not dippers. These findings suggest that the effect of exercise on 24-h BP varies according to the time of exercise and the type of nocturnal BP dipping.
Influence of eating behavior and obesity on diurnal BP variation
Food intake and postprandial hypotension
BP slightly rises during food intake but falls after eating. This BP elevation is due to increased physical activity during eating. The reduction in BP observed after eating is caused by a decrease in total peripheral resistance because of visceral vasodilation.39, 40 This BP reduction is small in healthy young subjects, but may be large in elderly subjects and hypertensive subjects and profound in patients with autonomic failure.40, 41, 42, 43 It is also greater after high-carbohydrate meals compared with high-fat meals.39 Although the mechanisms of postprandial hypotension have not been fully clarified, inadequate sympathetic nervous system compensation due to an impaired baroreceptor reflex, insulin-induced vasodilation and the release of vasodilatory gastrointestinal polypeptides may be involved. The postprandial BP reduction peaks at about 1 h after eating and persists for more than 2 h. Thus, it influences diurnal BP variation, particularly in elderly subjects with hypertension.
Obesity and sleep apnea
The relationship between obesity and hypertension is well known, and guidelines recommend weight reduction for overweight/obese subjects in order to manage hypertension. Obese subjects have higher daytime and nighttime BP compared with lean subjects; however, these subjects may also show altered diurnal BP variations and an increased prevalence of the nondipping status.44 Obstructive sleep apnea is prevalent among obese subjects and may contribute to hypertension in these individuals.45 It has been shown that obstructive sleep apnea predominantly increases nighttime BP and its variability because of BP surges due to hypoxia/hypercapnea during episodes of apnea.45, 46 Therefore, obesity and sleep apnea may cause nighttime hypertension (Table 1).
A number of studies have demonstrated that weight reduction is effective for lowering BP in hypertensive patients. In our studies, weight reduction with a hypocaloric diet was associated with significant decreases in 24-h BP in overweight/obese patients with hypertension, and the reductions in daytime and nighttime BP were comparable.47, 48 However, it has also been shown that weight reduction by gastric bypass surgery normalizes the blunted nocturnal fall observed in the BP of morbidly obese patients with impaired circadian BP.49
Dietary sodium and other electrolytes
Dietary sodium intake is closely related to BP and hypertension. The hypertensive effect of a high sodium diet is observed throughout the day, and sodium restriction decreases daytime and nighttime BP similarly in hypertensive patients.7 However, the degree of BP elevation induced by a high-sodium diet might be greater during night than day in salt-sensitive patients. It has been shown that these patients are likely to be nondippers when they consume much salt, but become dippers during sodium restriction.50
Sodium metabolism also shows diurnal variation, which is related to BP. Urinary sodium excretion is relatively high during the daytime and low during nighttime in normotensive and hypertensive subjects.16 This diurnal variation in sodium excretion is diminished or reversed in hypertensive nondippers.51 Impaired sodium excretion capacity in salt-sensitive patients may result in the elevation of nocturnal BP to stimulate natriuresis in order to restore sodium balance (Table 1).
The dietary intake of potassium, calcium and magnesium is inversely related to the BP, and clinical studies have shown significant reductions in BP after supplementation of these minerals.36 Current guidelines encourage the consumption of fruits and vegetables that are rich in potassium and magnesium and dairy products that are rich in calcium for the management of hypertension. In our studies, potassium, calcium and magnesium supplementation decreased ambulatory BP in hypertensive patients although the effect of calcium was not significant.52, 53, 54 We also observed that the hypotensive effects of potassium and calcium tended to be greater during nighttime than daytime, but the effect of magnesium was the same throughout the day. It has been shown that potassium and calcium mainly lower BP by natriuresis. Therefore, dietary intake of potassium and calcium may affect diurnal BP variation although their influence is small.
Diurnal BP variation in relation to drinking and smoking
Alcohol intake
The hypertensive effect of alcohol has been demonstrated in a number of observational and clinical studies.36, 55 However, alcohol has both pressor and depressor actions, and the latter is obvious in Asian subjects, especially in those who show alcohol flush. In our study, BP decreased and heart rate increased for several hours after alcohol ingestion in hypertensive patients.56 We also examined the effects of repeated alcohol intake in the evening under standardized conditions.7, 57 After 1 week, the BP of hypertensive patients decreased in the evening but increased in the early morning (Figure 1). We further investigated the effects of alcohol restriction for 4 weeks in habitual drinkers with hypertension.58, 59 In these studies, morning and daytime BP fell but evening and nighttime BP rose with alcohol restriction while mean BP did not change. Many dippers became nondippers and many extreme-dippers became dippers with alcohol restriction. Thus, drinking habit seems to be a risk factor for morning hypertension (Table 1). An elevation in morning BP without changes in mean 24-h BP in habitual drinkers was also observed in population-based epidemiological studies in Japan.60, 61
However, the effect of alcohol on 24-h BP may differ between Orientals and Caucasians. Rakic et al.62 observed elevations in daytime and mean 24-h BP without a change in nighttime BP after repeated alcohol consumption in Australian men. This racial difference is likely to be due to genetic variation in aldehyde dehydrogenase 2 (ALDH2) activity.55 Subjects with the ALDH2*2 genotype, which is common in Mongoloids but rare in Caucasians and Africans, show facial flush, tachycardia and hypotension after drinking alcohol because of the accumulation of acetaldehyde, but these changes are very small in subjects with the ALDH2*1 genotype.
Cigarette smoking
In epidemiological studies, smokers usually do not show higher levels of BP than nonsmokers. However, smoking acutely increases BP and heart rate by activating the sympathetic nervous system. Studies using ambulatory BP monitoring have revealed that daytime BP, but not nighttime BP, is higher in smokers than in nonsmokers and is higher on smoking than on nonsmoking days.8, 63 Therefore, smoking habit is associated with an increase in the day–night BP difference and is a cause of daytime hypertension (Table 1).
As smokers usually do not smoke in the medical environment, their BP may be normal when they visit a clinic but high during their daily life. It has been shown that the prevalence of current smokers was highest in the masked hypertension group among normotensive and hypertensive subjects.64
Effects of coffee and tea consumption
Coffee and tea contain a number of chemicals including caffeine and flavonoids. These beverages as well as cocoa and chocolate have certain effects on BP and cardiovascular disease although guidelines for the management of hypertension do not mention their consumption.
It has been shown that the consumption of coffee and tea acutely elevates BP.65, 66 This pressor response is usually moderate (about 10 mm Hg) and short in duration (about 1 h). The acute rise in BP is largely attributed to activation of the sympathetic nervous system by caffeine although other mechanism(s) may be involved. This effect can counteract the postprandial hypotension after a meal. However, flavonoids act to improve vascular function and antihypertensive effects of tea and cocoa have also been suggested.67, 68, 69 Meta-analyses of controlled clinical trials showed a small increase in BP associated with coffee consumption, no change due to tea consumption, and a significant reduction in BP after cocoa consumption.69, 70
Several studies have assessed the effect of caffeinated and flavonoid-rich drinks or food on 24-h BP. Small but significant reductions in morning, afternoon and evening BP were observed after the cessation of caffeinated coffee consumption in normotensive subjects.71 In another study, 24-h BP increased in hypertensive patients but not in normotensive subjects after coffee consumption.72 On the other hand, a significant reduction in 24-h BP and an improvement of endothelial function were shown in hypertensive patients after the consumption of dark chocolate.73
Therefore, the consumption of coffee and tea influences diurnal BP variation by causing a transient BP elevation. However, their effects on mean 24-h BP are small, and chronic tea consumption might act to protect against hypertension. Cocoa and chocolate appear to reduce casual and 24-h BP in hypertensive patients.
Influence of bathing
Taking a hot bath influences BP and its diurnal variation. BP usually rises at the beginning of bathing, then decreases during hot bath immersion, falls further immediately after bathing and then gradually returns toward the baseline level. These changes are physiological responses to high temperature and water immersion.
The post-bathing hypotension may be profound and lasts for about 1 h. Kawabe et al.74 studied the influence of bathing on home BP and observed a significant reduction in BP at 30 min and 31–60 min, but not at 61–120 min after bathing. They have also shown that post-bathing measurement of home BP is an independent determinant of a large morning–evening BP difference.75
Therefore, bathing results in BP reduction for a certain period. Post-bathing hypotension might be particularly pronounced in Japanese because many Japanese use deep bathtubs and a high water temperature for bathing.
Conclusions
Behavioral factors have an important role in diurnal BP variation. The diurnal changes in BP are closely related to mental and physical activities. Mental and physical stress elevates BP in the morning and during the daytime and may cause morning and daytime hypertension. Sleep disturbance elevates nighttime BP and may be responsible for nondipping. Obesity and excess sodium intake may cause a greater rise in nighttime BP than daytime BP in sensitive subjects. Alcohol consumption increases BP during the daytime, particularly in the morning, with little change in mean 24-h BP. Cigarette smoking increases daytime BP without altering nighttime BP. Coffee and tea consumption elevate BP for a short period but their effect on 24-h BP is small. Understanding these changes in BP caused by behavioral factors is important and leads to better management of hypertension. It should also be mentioned that exercise, food intake, alcohol ingestion and bathing cause subsequent BP reduction, especially in susceptible individuals.
References
Millar-Craig MW, Bishop CN, Raffery EB . Circadian variation of blood-pressure. Lancet 1978; i: 795–797.
Mancia G, Ferrari A, Gregorini L, Parati G, Pomidossi G, Bertinieri G, Grassi G, di Rienzo M, Pedotti A, Zanchetti A . Blood pressure and heart rate variabilities in normotensive and hypertensive human being. Circ Res 1983; 53: 96–104.
Muller JE, Tofler GH, Stone PH . Circadian variation and triggers of onset of acute cardiovascular disease. Circulation 1989; 79: 733–743.
Pickering TG . Variability of blood pressure. Blood Press Monit 1998; 3: 141–145.
Steptoe A, Roy MP, Evans O, Snashal D . Cardiovascular stress reactivity and job strain as determinants of ambulatory blood pressure at work. J Hypertens 1995; 13: 201–210.
Leary AC, Donnan PT, MacDonald TM, Murphy MB . Physical activity level is an independent predictor of the diurnal variation in blood pressure. J Hypertens 2000; 18: 405–410.
Kawano Y, Abe H, Kojima S, Yoshimi H, Sanai T, Kimura G, Matsuoka H, Takishita S, Omae T . Different effects of alcohol and salt on 24-h blood pressure and heart rate in hypertensive patients. Hypertens Res 1996; 19: 255–261.
Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Zampi I, Battistelli M, Gattobigio R, Sacchi N, Porcellati C . Cigarette smoking, ambulatory blood pressure and cardiac hypertrophy in essential hypertension. J Hypertens 1995; 13: 1209–1215.
Kawano Y . Biorhythm and hypertension. Asian Med J 2000; 43: 207–213.
Mancia G, Parati G, Castigioni P, Tordi R, Tortorici A, Glavina F, Di Rienzo M . Daily life blood pressure changes are steeper in hypertensive than in normotensive subjects. Hypertension 2003; 42: 277–282.
Kawano Y . Role of blood pressure monitoring in non-pharmacological management of hypertension. Blood Press Monit 2002; 7: 51–54.
Burke V, Beilin LJ, Cutt HE, Mansour J, Wilson A, Mori TA . Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomized controlled trial. J Hypertens 2005; 23: 1241–1249.
Turjanmaa V, Tuomisto M, Fredrikson M, Kalli S, Uusitalo A . Blood pressure and heart rate variability and reactivity as related to daily activities in normotensive men measured with 24-h intra-arterial recording. J Hypertens 1991; 9: 665–675.
Sherwood A, Stellen PR, Blumenthal JA, Kuhn C, Hinderliter AL . Nighttime blood pressure dipping: the role of the sympathetic nervous system. Am J Hypertens 2002; 15: 111–118.
Grassi G, Bombelli M, Seravalle G, Dell’Oro R, Quarti-Trevano F . Diurnal blood pressure variation and sympathetic activity. Hypertens Res 2010; 33: 381–385.
Kawano Y, Kawasaki T, Kawazoe N, Abe I, Uezono K, Ueno M, Fukiyama K, Omae T . Circadian variations of urinary dopamine, norepinephrine, epinephrine and sodium in normotensive and hypertensive subjects. Nephron 1990; 55: 277–282.
Chau NP, Mallion JM, de Gaudemaris R, Ruche E, Siche JP, Pelen O, Mathern G . Twenty-four-hour ambulatory blood pressure in shift workers. Circulation 1989; 80: 341–347.
Kitamura T, Onishi K, Dohi K, Okinaka T, Ito M, Isaka N, Nakano T . Circadian rhythm of blood pressure is transformed from dipper to a non-dipper pattern in shift workers with hypertension. J Hum Hypertens 2002; 16: 193–197.
Khoury AF, Sunderajan P, Kaplan NM . The early morning rise in blood pressure is related mainly to ambulation. Am J Hypertens 1992; 5: 339–344.
Leary AC, Struthers AD, Donnan PT, MacDonald TM, Murphy MB . The morning surge in blood pressure and heart rate is dependent on physical activity after waking. J Hypertens 2002; 20: 865–870.
Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, Murata M, Kuroda T, Schwarz JE, Shimada K . Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003; 107: 1401–1406.
Gosse P, Schmacher H . Early morning blood pressure surge. J Clin Hypertens 2006; 8: 584–589.
Verdecchia P, porcellati C, Schillaci G, Borgioni C, Ciucci A, Ballisteri M, Guerrieri M, Gatteschi C, Zampi I, Santucci A, Santucci C, Reboldi G . Ambulatory blood pressure: an independent predictor of prognosis in essential hypertension. Hypertension 1994; 24: 793–801.
Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M, Matsubara M, Hashimoto J, Yoshi A, Araki T, Tsuji I, Satoh H, Hisamichi S, Imai Y . Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens 2002; 20: 2183–2189.
Kawano Y, Horio T, Matayoshi T, Kamide K . Masked hypertension: subtypes and target organ damage. Clin Exp Hypertens 2008; 30: 289–296.
Murakami S, Otsuka K, Kubo Y, Shinagawa M, Yamanaka T, Ohkawa S, Kitaura Y . Repeated ambulatory monitoring reveals a Monday morning surge in blood pressure in a community-dwelling population. Am J Hypertens 2004; 17: 1179–1183.
Fauvel JP, Quelin P, Ducher M, Rakotomalala H, Laville M . Perceived job stress but not individual cardiovascular reactivity to stress is related to higher blood pressure at work. Hypertension 2001; 38: 71–75.
Baba S, Ozawa H, Nakamoto Y, Ueshima H, Omae T . Enhanced blood pressure response to regular daily stress in urban hypertensive men. J Hypertens 1990; 8: 647–655.
Harada K, Karube Y, Saruhara H, Takeda K, Kuwajima I . Worksite hypertension is associated with obesity and family history of hypertension. Hypertens Res 2006; 29: 969–976.
Okuda N, Kawano Y, Horio T, Makino Y, Iwashima Y, Takishita S . The effect of hospitalization on circadian rhythm of blood pressure: a comparison between inpatient and outpatient periods. Ther Res 1998; 19: 2699–2701.
Barnes VA, Triber FA, Johnson MH . Impact of transcendental meditation on ambulatory blood pressure in African-American adolescents. Am J Hypertens 2004; 17: 366–369.
Manikonda JP, Stork S, Togel S, Lobmeller A, Grunberg I, Bedel S, Schordt F, Angermann CE, Johns R, Voelker W . Contemplative meditation reduces ambulatory blood pressure and stress-induced hypertension: a randomized pilot trial. J Hum Hypertens 2008; 22: 138–140.
Davis RJO, Jenkins NE, Stradling JR . Effect of measuring ambulatory blood pressure on sleep and blood pressure during sleep. BMJ 1994; 308: 820–823.
Mansoor GA . Sleep actigraphy in hypertensive patients with the ‘non-dipper’ blood pressure profile. J Hum Hypertens 2002; 16: 237–242.
Kenney MJ, Seals DR . Postexercise hypotension: key features, mechanisms, and clinical significance. Hypertension 1993; 22: 653–664.
Kawano Y, Omae T . Lifestyle modifications in the management of hypertension: benefits and limitations. CVD Prevention 1998; 1: 336–346.
Miyai N, Arita M, Miyashita K, Morioka I, Shiraishi T, Nishio I, Takeda S . Antihypertensive effects of aerobic exercise in middle-aged normotensive men with exaggerated blood pressure response to exercise. Hypertens Res 2002; 25: 507–514.
Park S, Jastremski CA, Wallace JP . Time of day for exercise on blood pressure variation in dipping and nondipping hypertension. J Hum Hypertens 2005; 19: 597–605.
Sydery MB, Cowley AJ, MacDonald IA . Cardiovascular responses to a high-fat and a high-carbohydrate meal in healthy elderly subjects. Clin Sci 1993; 84: 263–270.
Jansen RWMM, Lipsitz LA . Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med 1995; 122: 286–295.
deMey C, Enterling D, Brendel E, Meineke I . Postprandial changes in supine and elect heart rate, systemic blood pressure and plasma noradrenaline and rennin activity in normal subjects. Eur J Clin Pharmacol 1987; 32: 471–476.
Jansen RWMM, Penterman BJM, van Lier HJJ, Hoefnagels WHL . Blood pressure reduction after oral glucose loading and its relation to age, blood pressure and insulin. Am J Cardiol 1987; 60: 1087–1091.
Robertson D, Wade D, Robertson RM . Postprandial alterations in cardiovascular hemodynamics in autonomic dysfunctional states. Am J Cardiol 1981; 48: 1048–1052.
Kotsis V, Stabouli S, Bouldin M, Low A, Toumarinidis S, Zakopoulos N . Impact of obesity on 24-h ambulatory blood pressure and hypertension. Hypertension 2005; 45: 602–607.
Work R, Schamsuzzaman ASM, Somers VK . Obesity, sleep apnea, and hypertension. Hypertension 2003; 42: 1067–1074.
Kario K . Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure. Hypertens Res 2009; 32: 428–432.
Minami J, Kawano Y, Ishimitsu T, Matsuoka H, Takishita S . Acute and chronic effects of a hypocaloric diet on 24-h blood pressure, heart rate and heart rate variability in mildly-to-moderately obese patients with essential hypertension. Clin Exp Hypertens 1999; 21: 1413–1427.
Kawano Y, Okuda N, Minami J, Takishita S, Omae T . Effects of a low energy diet and an insulin-sensitizing agent on ambulatory blood pressure in overweight hypertensive patients. J Hypertens 2000; 18: 1451–1455.
Crupryniak L, Strzekzyk J, Pawlowski M, Loba J . Circadian blood pressure variation in morbidly obese hypertensive patients undergoing gastric bypass surgery. Am J Hypertens 2005; 18: 446–451.
Uzu T, Ishikawa K, Fujii K, Nakamura S, Inenaga T, Kimura G . Sodium restriction shifts circadian rhythm of blood pressure from nondipper to dipper in essential hypertension. Circulation 1997; 96: 1859–1862.
Fujii T, Uzu T, Nishimura M, Takeji M, Kuroda S, Nakamura S, Inenaga T, Kimura G . Circadian rhythm of natriuresis disturbed in non-dipper type of essential hypertension. Am J Kidney Dis 1999; 33: 29–35.
Kawano Y, Minami J, Takishita S, Omae T . Effects of potassium supplementation on office, home, and 24-h blood pressure in patients with essential hypertension. Am J Hypertens 1998; 11: 1141–1146.
Kawano Y, Yoshimi H, Matsuoka H, Takishita S, Omae T . Calcium supplementation in patients with essential hypertension: assessment by office, home and ambulatory blood pressure. J Hypertens 1998; 16: 1693–1699.
Kawano Y, Matsuoka H, Takishita S, Omae T . Effects of magnesium supplementation in hypertensive patients: assessment by office, home, and ambulatory blood pressures. Hypertension 1998; 32: 260–265.
Kawano Y . Physio-pathological effects of alcohol on the cardiovascular system: its role in hypertension and cardiovascular disease. Hypertens Res 2009; 33: 181–191.
Kawano Y, Abe H, Kojima S, Ashisa T, Yoshida K, Imanishi M, Yoshimi H, Kimura G, Kuramochi M, Omae T . Acute depressor effect of alcohol in patients with essential hypertension. Hypertension 1992; 20: 219–226.
Abe H, Kawano Y, Kojima S, Ashida T, Kuramochi M, Matsuoka H, Omae T . Biphasic effects of repeated alcohol intake on 24-h blood pressure in hypertensive patients. Circulation 1994; 89: 2626–2633.
Kawano Y, Abe H, Takishita S, Omae T . Effects of alcohol restriction on 24-h ambulatory blood pressure in Japanese men with hypertension. Am J Med 1998; 105: 307–311.
Kawano Y, Pontes CS, Abe H, Takishita S, Omae T . Effects of alcohol consumption and restriction on home blood pressure in hypertensive patients: serial changes in the morning and evening records. Clin Exp Hypertens 2002; 24: 33–39.
Ohira T, Tanigawa T, Tabata M, Imano H, Kitamura A, Kiyama M, Sato S, Okamura T, Cui R, Koike KA, Shimamoto T, Iso H . Effects of habitual alcohol intake on ambulatory blood pressure, heart rate, and its variability among Japanese men. Hypertension 2009; 53: 13–19.
Nakashita M, Ohkubo T, Hara A, Metoki H, Kikuya M, Hirose T, Tsubota-Utsugi M, Asayama K, Inoue R, Kanno A, Obara T, Hoshi H, Tatsune K, Satoh H, Imai Y . Influence of alcohol intake on circadian blood pressure variation in Japanese men: the Ohasama study. Am J Hypertens 2009; 22: 1171–1176.
Rakic V, Puddey IB, Burke V, Dimmitt SB, Beilin LJ . Influence of pattern of alcohol intake on blood pressure in regular drinkers: a controlled trial. J Hypertens 1998; 16: 165–174.
Minami J, Ishimitsu T, Matsuoka H . Effects of smoking cessation on blood pressure and heart rate variability in habitual smokers. Hypertension 1999; 33: 586–590.
Hansen TW, Kikuya M, Thijs L, Bjorlund-Bordegard K, Kuznetsova T, Ohkubo T, Richart T, Torp-Pedersen C, Lind L, Jeppesen J, Ibsen H, Imai Y, Staessen JA . Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7030 individuals. J Hypertens 2007; 25: 1554–1564.
Corti R, Binggeli C, Sudaro I, Spleker L, Hanseler E, Ruschitzka F, Chaptin WF, Luscher TF, Noll G . Coffee acutely increases sympathetic nerve activity and blood pressure independently of caffeine content: role of habitual and nonhabitual drinking. Circulation 2002; 106: 2935–2940.
Hodgson JM, Puddey IB, Burke V, Beilin LJ, Jordan N . Effects on blood pressure of drinking green and black tea. J Hypertens 1999; 17: 457–463.
Hodgson JM . Effects of tea and tea flavonoids on endothelial function and blood pressure: a brief review. Clin Exp Pharmacol Physiol 2006; 33: 838–841.
Yang YC, Lu FH, Wu JS, Wu CH, Chang CJ . The protective effect of habitual tea consumption on hypertension. Arch Intern Med 2004; 164: 1534–1540.
Taubert D, Roesen R, Shormig E . Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med 2007; 167: 626–634.
Jae SH, He J, Whelton PK, Suh I, Klag MJ . The effect of chronic coffee drinking on blood pressure: a meta-analysis of controlled clinical trials. Hypertension 1999; 33: 647–652.
Superko HR, Myll J, DiRicco C, Williams PT, Bortz WM, Wood PD . Effects of cessation of caffeinated-coffee consumption on ambulatory blood pressure in men. Am J Cardiol 1994; 73: 780–784.
Rakic V, Burke V, Beilin LJ . Effects of coffee on ambulatory blood pressure in older men and women: a randomized controlled trial. Hypertension 1999; 33: 869–873.
Grassi D, Necotione S, Lippi C, Croce G, Valeri L, Pasqualetti P, Desideri G, Blumberg JB, Ferri C . Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension 2005; 46: 398–405.
Kawabe H, Saito I . Influence of nighttime bathing on evening home blood pressure measurements: how long should be interval be after bathing? Hypertens Res 2006; 29: 129–133.
Kawabe H, Saito I . Determinants of exaggerated difference in morning and evening home blood pressure in Japanese normotensives. Hypertens Res 2009; 32: 1028–1031.
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Kawano, Y. Diurnal blood pressure variation and related behavioral factors. Hypertens Res 34, 281–285 (2011). https://doi.org/10.1038/hr.2010.241
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DOI: https://doi.org/10.1038/hr.2010.241
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Sports Medicine - Open (2023)
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Oral hygiene, mouthwash usage and cardiovascular mortality during 18.8 years of follow-up
British Dental Journal (2023)
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The Effects of Acute Exposure to Prolonged Sitting, with and Without Interruption, on Peripheral Blood Pressure Among Adults: A Systematic Review and Meta-Analysis
Sports Medicine (2022)
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Circadian variations in the occurrence of first‐ever intracerebral hemorrhage from different sources of income: a hospital‐based cross‐sectional study
BMC Neurology (2021)