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Circadian Variation of Cardiovascular Events and Morning Blood Pressure Surge

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Most cardiovascular functions exhibit circadian changes. On one hand, predictable-in-time differences in the physiological status of the cardiovascular system give rise to rhythmic variations in the susceptibility to morbid and mortal events. On the other, the pathological mechanisms of cardiovascular disease exhibit temporal changes in both their manifestation and severity, leading to predictable-in-time differences in the ability to precipitate the overt expression of disease. It is known that the occurrence of cardiovascular events shows temporal patterns that vary with time. The incidence of potentially life-threatening cardiovascular events, e.g. acute myocardial ischemia and infarction, sudden cardiac death, ischemic and hemorrhagic stroke, and rupture or dissection of aortic aneurysms, displays a diurnal pattern, tending to be higher in the morning. On arousal and the start of daily activities, blood pressure (BP) shows a surge that may last 4- 6 h. Morning BP surge, together with circadian variations in biochemical and physiological parameters, may be potential triggers for acute cardiovascular events. This may open up potential for applications in medical therapy. It is possible that antihypertensive medication given once daily in the morning may not protect against this surge if its duration of action is too short. Thus, the timing of drug administration or specific drug delivery systems that lead to a greater effect at night and/or mitigate the early morning BP surge may provide protection against cardiovascular events.

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Keywords: Blood pressure; aneurysm dissection; cardiovascular diseases; chronobiology; circadian rhythm; morning blood pressure surge; myocardial infarction; pulmonary embolism; risk factors; stroke

Document Type: Research Article

Publication date: 01 November 2008

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  • Vascular Disease Prevention publishes reviews as well as original papers to update all those concerned with this topic at the clinical or scientific level. In addition to clinically relevant topics, we consider reviews and original papers dealing with the more scientific aspects of vascular disease prevention. This includes the evaluation of emerging vascular risk factors, research dealing with the pathogenesis of atherosclerosis and the investigation of new treatment options both at the clinical and scientific level (e.g. epidemiology, patient-based studies, experimental models, in vitro experiments or molecular research). Therefore, another function of Vascular Disease Prevention is to bridge the gap between clinical practice and ongoing laboratory-based research.

    In particular, we welcome critical reviews and comments on recent trials. This is a topic that requires regular updates because of the large number of trials published every year.

    Debates are encouraged in the correspondence section of this journal.
    The editorial structure of Vascular Disease Prevention is set up with the aim of dealing with the submitted material as rapidly as possible. Specialist editors will provide a more expert and rapid assessment unlike a more centralized editorial structure.
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