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Causes and Mechanisms of Nondipping Hypertension

Profile image of Adrian CovicAdrian CovicProfile image of Faruk TurgutFaruk Turgut

2008, Clinical and Experimental Hypertension

https://doi.org/10.1080/10641960802251974
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Abstract

Growing evidence indicates that nondippers have worsened cardiovascular outcomes than dippers. Ambulatory blood pressure monitoring with a lack of nocturnal BP fall (nondipping) have also been shown to be more closely associated with target organ damage and worsened cardiovascular outcome than in patients with essential hypertension with dipping pattern. The underlying pathogenetic mechanisms potentially linking nondipping with cardiovascular disease are not fully understood. There are multiple possible underlying pathophysiologic mechanisms in the impaired BP decline during the night. Extrinsic and intrinsic factors including abnormal neurohormonal regulation, lack of physical activity, nutritional factors such as increased dietary sodium intake, and smoking of tobacco have been implicated for blunted circadian rhythm of BP. Certain diseases such as diabetes and chronic renal diseases also affect the circadian BP rhythm. Currently, the clinical importance of nondipping is known well; however, the relationship between certain disease states and nondipping has not been fully explained yet. This paper will attempt to address to clarify the underlying basis for nondipping and the specific associations with various disease states. 586 M. Kanbay et al.

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Nocturnal Hypertension or Nondipping: Which Is Better Associated With the Cardiovascular Risk Profile?
Manuel Gorostidi

American Journal of Hypertension, 2013

background Both increased night blood pressure (BP) and nondipping are associated with worse cardiovascular risk and prognosis. However, as they are often related features, their relative importance has been difficult to assess separately. In this study we address separate associations of nocturnal hypertension and nondipping with cardiovascular risk profile in treated and untreated hypertensive patients. methods A total of 37,096 untreated patients and 62,788 patients receiving antihypertensive treatment from the Spanish Ambulatory Blood Pressure Monitoring Registry were included. Each cohort was separated into 4 groups: group 1, night systolic blood pressure (SBP) <120 mm Hg and normal dipping (>10%); group 2, night SBP <120 mm Hg and nondipping (≤10%); group 3, nocturnal hypertension (SBP ≥120 mm Hg) and normal dipping; and group 4, nocturnal hypertension and nondipping. results The smallest proportion of patients with additional cardiovascular risk factors, organ damage, and history of previous events was observed in the group with both normal night SBP and dipping, whereas those with both nocturnal hypertension and nondipping showed the largest proportion of cardiovascular risk factors and diseases. When groups showing only 1 abnormality were compared, nondipping was associated with female sex, reduced renal function, and previous cardiovascular events, whereas nocturnal hypertension was associated with male sex, smoking, and increased urinary albumin excretion. In treated patients, it was also associated with the presence of diabetes. conclusion Nondipping is related to more advanced disease (reduced renal function and clinical evidence of cardiovascular disease), whereas nocturnal hypertension is associated with albuminuria. The worst cardiovascular risk profile is present in patients exhibiting both nocturnal hypertension and nondipping.

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Prognostic Value of Subdivisions of Nighttime Blood Pressure Fall in Hypertensives Followed Up for 8.2 Years. Does Nondipping Classification Need to Be Redefined?
Jorge Polónia

The Journal of Clinical Hypertension, 2010

To evaluate the long-term prognostic significance of different ranges of the percentage fall in nighttime blood pressure (BP) of the nondipping pattern, 1200 hypertensive patients 645 women, age 51AE12 years) underwent ambulatory BP monitoring under stabilized therapy. The occurrence of cardiovascular (CV) events was followed for 9833 patient-years and analyzed by the Cox hazard model. There were 152 CV fatal ⁄ nonfatal events (79 strokes, 51 coronary events, 22 others) during the 15.2 years of follow-up. According to nighttime BP fall (%) the authors noted: <0% (reverse-dippers [RD], n=83); 0%-4.9% (nondippers 1 [ND1], n=207); 5%-9.9% (nondippers 2 [ND2], n=311), 10%-19.9% (dippers [D], n=523); and !20% (extreme dippers [ED], n=76). After adjustment for confounding variables, hazard ratios (95% confidence interval) of CV event and stroke in RD vs D were 2.29 (1.31-3.99) and 2.46 (1.11-5.49); of ND1 vs D were 1.42 (1.12-1.79) and 1.62 (1.17-2.23); and of ND1 vs ND2 were 2.24 (1.33-3.75) and 2.30 (1.15-4.58). No differences were found in RD vs ND1 and ND2 vs D. Nondippers have a higher CV risk than dippers but only for a nighttime BP fall <5% suggesting that the limits for nondipping should be redefined for a stratification of CV risk. J Clin Hypertens (Greenwich). 2010;12:508-515. ª 2010 Wiley Periodicals, Inc.

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Circadian variability and nocturnal dipping pattern in blood pressure in young normotensive subjects
Arti Parganiha

Biological Rhythm Research, 2012

Blood pressure variability (BPV) is one of the recognized risk factors for different types of cardiovascular diseases (CVDs). Several physiological, behavioral and ethnic factors are known to modulate blood pressure (BP). Such studies on the population of southeast India are altogether absent. It is worthwhile, therefore, to examine the circadian variability in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) and nocturnal dipping pattern in BP in apparently healthy human subjects as a function of gender. Sixty females and 40 males voluntarily participated in the study. All subjects wore an Ambulatory Blood Pressure Monitor (ABPM, TM 2430) for two to four consecutive days. SBP, DBP and HR was measured every 15 and 30 minutes between 07:00-22:00 and 22:00-07:00 hrs, respectively. In addition, double product (DP) and mean arterial pressure (MAP) were also computed. Data were analyzed using A&D, Cosinor and Spectre software. Prevalence of extreme dipper, dipper and nondipper was 13%, 63% and 24%, respectively. A statistically significant circadian rhythm was validated in all studied variables, irrespective of gender and dipping pattern in BP. However, the rhythm detection ratio was low among non-dippers. Chi-square test revealed a statistically significant association of the frequency of prominent periods of SBP and MAP with nocturnal dipping categories. Further, significant differences for the circadian Mesors of SBP, DBP, HR, DP and MAP and acrophase of DBP and MAP were noticed between males and females. Dipping pattern produced a significant effect on the rhythm characteristics of all the studied variables. On the basis of our findings we can conclude that variability in BP may be associated with factor gender to some extent, whereas nocturnal dipping in BP is independent of gender. Interestingly in the present study about 24% subjects are non-dippers, which may be an indication of higher risk of CVDs among individuals belonging to younger generation of this region. However, further extensive study is desirable to strengthen the above conjecture.

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Nocturnal nondipping of heart rate predicts cardiovascular events in hypertensive patients
Joseph Schwartz

2009

Objective-It is not established whether nocturnal non-dipping of heart rate predicts future cardiovascular disease. We performed this study to test the hypothesis that nocturnal non-dipping of heart rate predicts the risk of incident cardiovascular disease (CVD) independent of nocturnal BP dipping pattern. Methods-Ambulatory blood pressure monitoring was performed in 457 uncomplicated patients, who were being treated or evaluated for hypertension. They were followed for an average of 72 ± 26 months. Non-dipping heart rate was defined as a night/day heart rate ratio greater than 0.90. We chose two outcomes for this analysis: CVD events (defined as stroke, myocardial infarction, or sudden cardiac death), and all-cause mortality. Cox regression analyses (stepwise method) were used to estimate hazard ratios and their 95%CI, after adjusting for covariates. Results-In univariate analysis, increased sleep heart rate and non-dipping of heart rate were associated with increased risk of CVD and all-cause mortality, but awake heart rate was not. In multivariable analyses, heart rate non-dipping status significantly predicted an increased risk of CVD events (hazard ratio=2.37, 95%CI=1.22-4.62, P=0.01), but not for all-cause mortality. Increased 24-hour heart rate was significantly associated with increased risk of all cause mortality (hazard ratio=1.67, 95%CI=1.11-2.51, P=0.01). Conclusions-The risk of future CVD was shown to be 2.4 times as great in those whose heart rate does not exhibit the typical nocturnal decline. The relationship was independent of nondipping of SBP and did not dependent on diabetes status or BP level.

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Clinical impact of dipping and nocturnal blood pressure patterns in newly diagnosed, never-treated patients with essential hypertension
Areti Triantafyllou

Journal of The American Society of Hypertension, 2018

The significance of non-dipping and increased nighttime systolic blood pressure (SBP) in established hypertension is well-defined. We investigated whether these factors alone or combined correlate with vascular damage in early-stage hypertension. Newly diagnosed, untreated hypertensives were classified as dippers and non-dippers according to ambulatory blood pressure (BP). 24-h urinary albumin excretion (UAE) and markers of arterial stiffness (pulse wave velocity, augmentation index, central and peripheral pulse pressure, central BP) and atherosclerosis (carotid intima-media thickness) were assessed. Serum asymmetric dimethylarginine (ADMA), an index of endothelial dysfunction, was measured in a study subgroup; 10-year cardiovascular risk was calculated. Among 222 hypertensives, only UAE was increased in nondippers, compared to dippers (p=0.026). When dippers were further stratified according to nighttime SBP (<120 or ≥120 mmHg), the first group demonstrated the lowest levels of office, aortic, 24-hour, day-and nighttime BP, compared to dippers with elevated nighttime SBP and non-dippers. Although vascular measurements and ADMA were comparable between these groups, dippers with normal nighttime SBP exhibited the lowest cardiovascular risk score (p=0.050). In early-stage hypertension, non-dipping was accompanied by microvascular, yet not macrovascular and endothelial dysfunction. Dippers with elevated nighttime SBP appear as a distinct group with increased hemodynamic pressure load and cardiovascular risk.

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Orthostatic hypotension is associated with nocturnal change in systolic blood pressure
Ehud Grossman

2012

original contributions nature publishing group Ambulatory blood pressure monitoring (ABPM) in normotensive and hypertensive subjects demonstrates a dipping blood pressure (BP) circadian pattern with a 10% decrease in BP readings at night. Some patients demonstrate a decrease of less than 10% (nondipping) or even an increase in BP at night (reverse-dipping). 1 A nondipping pattern is observed in elderly, diabetics, patients with sleep apnea syndrome, patients with metabolic syndrome, in patients with several forms of secondary hypertension and is associated with increased cardiovascular (CV) morbidity and mortality. 2-4 Orthostatic hypotension (OH) is defined as a decline of at least 20 mm Hg in systolic BP, and/or 10 mm Hg in diastolic BP, when changing from the recumbent to an upright position. 5 The incidence of OH increases with age and is common in individuals with peripheral neuropathy and autonomic failure. The association between OH and CV morbidity and mortality is controversial. 6-9 Weiss et al. failed to show increased mortality in elderly patients with OH, 9 whereas several other studies have shown that OH is associated with CV morbidity and mortality. 6-8 Many patients with autonomic failure have both OH and a nondipping BP pattern. 10 Circadian patterns of BP have not been well studied among individuals with OH. Moreover, there is little data relating postural BP changes to nocturnal BP changes. We hypothesized that the changes in BP during upright posture may contribute to the circadian pattern of BP. Therefore, we designed this prospective study to evaluate whether OH is associated with an abnormal dipping BP pattern, and whether nocturnal changes in BP levels are related to postural BP changes. Methods This was a prospective study that included 185 consecutive hypertensive patients, who were referred for 24-h ABPM at the Chaim Sheba Medical Center's hypertension unit either to confirm the diagnosis of hypertension before treatment, or to assess BP control. Participants were included in the study if they were able to lie down for 5 min and stand up for 3 min without any external support. Patients with sleep apnea di agnosed in a sleep laboratory, and patients with documented The first two authors contributed equally to this study and are co-first authors of this manuscript.

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Diurnal blood pressure pattern and development of prehypertension or hypertension in young adults: the CARDIA study
Sharina Person

Journal of the American Society of Hypertension, 2011

Nondippers (people whose sleep systolic blood pressure (SBP) fails to decrease >10% from daytime SBP) have increased risk of cardiovascular disease. The prevalence of nondipping in younger adults has not been well-studied, nor has its value for predicting hypertension. We examined the prevalence of nondipping in a sub-study of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We used Cox regression to estimate the hazard ratio (HR) conferred by nondipping for incident prehypertension or hypertension (preHTN/HTN) over 15 years. Of the 264 non-hypertensive participants at baseline, 118 (45%) were nondippers. Blacks were more likely than Whites to be nondippers (52% vs 33%, p=0.004). The incidence rate of preHTN/HTN was 29.2/1000 person-years among dippers and 36.2/1000 person-years among nondippers. Compared to those in the lowest quartile of nighttime to daytime SBP, those in the highest quartile were more likely to develop preHTN/HTN (HR 1.61; p =0.06), but this relationship was attenuated after adjustment (HR 1.34; p =0.27). Our results demonstrate that nondipping is common in young, nonhypertensive adults, and is more common in Blacks than Whites. Nondipping might predate a meaningful clinically detected increase in BP in some people, but more research in larger study samples is needed.

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Circadian blood pressure: Clinical implications based on the pathophysiology of its variability
Aldo Peixoto

Kidney International, 2007

In the early morning, BP rises sharply in response to the natural activation of the sympathetic nervous system on morning arousal. 6-10 This early morning surge is also http://www.kidney-international.org

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Circadian variations in blood pressure in health and disease: implications for patient management
Mark S. Slaughter

ChronoPhysiology and Therapy, 2011

Traditionally, blood pressure measurements have been performed in office settings and have provided the basis for all diagnostic and therapeutic decisions. However, the development of a clinically relevant 24-hour blood pressure monitoring system has added greatly to the ability of blood pressure values to confer additional clinical information, including prognostic value. Mechanistically, the circadian rhythm of blood pressure is mediated by a complex process as a part of the neurohormonal cascade. Pattern recognition of blood pressure peaks and troughs over a 24-hour period has led to categorization into specific subsets namely, ie, dippers, nondippers, extreme dippers, and reverse dippers. Cardiovascular risk is associated with certain pattern types, as has been demonstrated in large observational and prospective studies. The development of therapies for the purpose of restoring more pathological patterns to normal ones continues to grow. These include both pharmaceutical and device therapy. This article describes the development of 24-hour blood pressure monitoring systems, the identification of circadian blood pressure patterns, and the treatment strategies studied thus far which affect these newer blood pressure parameters.

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Does nondipping of blood pressure at night reflect a trait of blunted cardiovascular responses to daily activities?
Danny Asogun

Annals of Behavioral Medicine, 2004

Background: Individuals who fail to show a decline in blood pressure (BP) when asleep or at night (labeled nocturnal nondippers) are at elevated risk for hypertension and associated target-organ damage. Purpose: We tested whether the well-established changes in BP exhibited in response to daily activities are also blunted in nocturnal nondippers. Methods: Cross-sectional study of 41 women and 56 men, aged 27 to 71 years, residing in Benin, Nigeria, enrolled in a health survey of civil servants. Ambulatory 24-hr BP monitoring was performed with concurrent diary recordings of physical activity level, posture, location, state of mental activity, interpersonal interaction, and mood obtained during the waking hours. Results: Nocturnal nondippers exhibited smaller cardiovascular responses to changes in posture (from lying to sitting or to standing, ps < .02), location (from home to work or to driving/riding in a car, ps < .02), mental activity (from relaxed to active, p = .02), and mood (from feeling mellow to feeling elated-happy, p = .05) than did dippers. Statistical controls for posture substantially reduced the effects of nondipping status on responses to other daily activities and mood. Lack of systolic BP responsiveness to postural changes during the day is a strong predictor of nondipping status. Conclusions: Nondipping at night appears to extend to decreased cardiovascular responses to changes in activities during daytime hours.

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Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients
Antonio Sarría

Hypertension, 2009

Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In addition to 24-hour values, the circadian variation of BP adds prognostic significance in predicting cardiovascular outcome. However, the magnitude of circadian BP patterns in large studies has hardly been noticed. Our aims were to determine the prevalence of circadian BP patterns and to assess clinical conditions associated with the nondipping status in groups of both treated and untreated hypertensive subjects, studied separately. Clinical data and 24-hour ambulatory BP monitoring were obtained from 42 947 hypertensive patients included in the Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry. They were 8384 previously untreated and 34 563 treated hypertensives. Twenty-four-hour ambulatory BP monitoring was performed with an oscillometric device (SpaceLabs 90207). A nondipping pattern was defined when nocturnal systolic BP dip was Ͻ10% of daytime systolic BP. The prevalence of nondipping was 41% in the untreated group and 53% in treated patients. In both groups, advanced age, obesity, diabetes mellitus, and overt cardiovascular or renal disease were associated with a blunted nocturnal BP decline (PϽ0.001). In treated patients, nondipping was associated with the use of a higher number of antihypertensive drugs but not with the time of the day at which antihypertensive drugs were administered. In conclusion, a blunted nocturnal BP dip (the nondipping pattern) is common in hypertensive patients. A clinical pattern of high cardiovascular risk is associated with nondipping, suggesting that the blunted nocturnal BP dip may be merely a marker of high cardiovascular risk. (Hypertension. 2009;53:466-472.) Key Words: circadian blood pressure pattern Ⅲ nocturnal blood pressure dip Ⅲ cardiovascular risk factors Ⅲ ambulatory blood pressure monitoring Ⅲ hypertension Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.

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Variability of diurnal changes in ambulatory blood pressure and nocturnal dipping status in untreated hypertensive and normotensive subjects
Lesley Rushton

American Journal of Hypertension, 2000

An absent or diminished blood pressure (BP) fall during sleep (so-called "nondipping") has been associated with a higher risk of cardiovascular complications, but the long-term reproducibility of dipper status and the relationship between diurnal changes in BP and perceived sleep quality have not been previously documented in untreated hypertensive patients. Ambulatory BP (ABP) and dipping status were examined in 79 subjects (69 hypertensives and 10 normotensives) at 0, 6, and 12 months. Fifty-six percent of subjects had no change in their dipping status, the majority (53%) dipping normally on all three occasions. However, 44% of patients had variable dipping status, and normal nighttime dipping in BP was observed more often when patients perceived their sleep quality to be good during the period of ABP recording. These results highlight significant intrasubject variability in the diurnal fluctuations in ABP and dipper status, which may in part reflect day-today variations in sleep disturbance during ABP monitoring. Classifying hypertensive patients into dippers or nondippers on the basis of a single ABP recording is unreliable and potentially misleading.

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Abnormal blood pressure circadian rhythm: A target organ damage?
Vincent Launay-vacher

International Journal of Cardiology, 2006

Blood pressure (BP) varies according to cycles characterized by a reduction during sleep and an increase on awakening. The nighttime decrease is absent or blunted in some patients (termed ''non-dippers''). Cross-sectional and prospective data have shown that non-dippers have more target organ damage than have dippers in normotensive and hypertensive subjects. We reviewed the English language literature regarding this association.

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Circadian Blood Pressure Profile and Associated Cardiovascular Risk Factors in Non-Dippers
Siti Suhaila Mohd Yusoff

2020

Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers. Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12. Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic. Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.

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Limited Reproducibility of Circadian Variation in Blood Pressure Dippers and Nondippers
Ken Umetani

American Journal of Hypertension, 1998

The relation between blood pressure (BP) variation and hypertensive organ damage is controversial. The reproducibility of the circadian variation pattern acceptable as the standard for discriminating between ''dippers'' and ''nondippers'' has not yet been evaluated. We evaluated the reproducibility of ''dipper'' and ''nondipper'' patterns in essential hypertensives by monitoring BP for 48 h. Noninvasive ambulatory BP and heart rate (HR) monitoring for 48 h every 30 min were performed in 253 untreated patients with mild-to-moderate essential hypertension. Mean daytime (awake) and nighttime (sleeping) systolic BP, diastolic BP, and HR values were analyzed by reviewing the patients' diaries. Patients were divided into two groups by presence (dippers) and absence (nondippers) of a reduction of both systolic and diastolic BP during the night of > 10% of the daytime pressure. A subject who was a dipper on day 1 remained a dipper on day 2 in 41% (n ‫؍‬ 103, DD group) and changed to nondipper in 16% (n ‫؍‬ 41, DN group). A subject who was a nondipper on day 1 remained a nondipper on day 2 in 30% (n ‫؍‬ 75, NN group) and changed to a dipper in 13% (n ‫؍‬ 34, ND group). Our findings indicate that there is a high risk of false-positive or false-negative results when 24-h recordings are used to identify dipper and nondipper profiles.

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    Omoyemi Ogwumike, Arinola O. Sanya

    BioMed Research International, 2013

    Gender is a major determinant of the outcomes of many health interventions. This study documents the order of significant improvements in metabolic parameters of patients with type 2 diabetes mellitus (T2DM) having metabolic syndrome within 12 weeks of physical exercise programmes. Twenty-nine patients, mean age 49.6 ± 3.7 years, presenting with high fasting plasma glucose, high triglycerides, hypertension, and high waist circumference undertook a thrice weekly aerobic and endurance exercise programme in addition to their drugs and diet. Variables were assessed at baseline and end of every two weeks for twelve weeks. Compared with baseline, significant improvement ( < 0.05) in the metabolic parameters occurred in this order for the male participants: fasting glucose (2nd week), triglycerides and waist circumference (4th week), and systolic blood pressure (12th week). For the female participants, it was fasting glucose (4th week), triglycerides (6th week), and waist circumference (10th week). Regardless of the gender, fasting glucose was the first to improve significantly, followed by triglycerides. Hypertension did not improve significantly at all in the female participants as they may require more than twelve weeks of therapeutic exercise for any significant improvement in hypertension.

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    Nocturia as a manifestation of systemic disease
    Marcus Drake

    BJU International, 2011

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    Behavioural and psychosocial correlates of nondipping blood pressure pattern among middle-aged men and women at work
    De Bacquer

    Journal of Human Hypertension, 2012

    The underlying pathogenetic mechanisms of nondipping blood pressure (BP) pattern are not completely understood. Especially the role of psychosocial correlates remains unclear. The aim was to assess the association between nondipping BP pattern, behavioural and psychosocial factors in a sample of working men and women. The study sample included 167 working men and women aged 40-64 years from the BELSTRESS cohort. Sociodemographic, behavioural and psychosocial factors were assessed by self-administered questionnaires. Participants were medically examined and underwent an ambulatory BP monitoring during 24 h. Nondipping was defined when the average nocturnal decline in BP was o10%. The prevalence of nondipping for both systolic and diastolic BP was 7.8%. Nondipping was not significantly related to smoking, alcohol consumption and leisure time physical activity. A crude significant association was observed between nondipping and sleep problems. After adjusting for gender, education and body mass index, the risk for nondipping was associated with job strain, living alone, being unsatisfied about the contact with one's children, depressive symptoms and vital exhaustion. Nondipping BP pattern was consistently related to psychosocial factors in this study: positive associations were observed with measures of job strain, poor private life support (living alone and being unsatisfied about the contact with one's children) and mental health problems (depressive symptoms and vital exhaustion).

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    Obesity Induces Disruption of Microvascular Endothelial Circadian Rhythm
    Zachary Corley

    Frontiers in Physiology, 2022

    Obese individuals are at significantly elevated risk of developing cardiovascular disease (CVD). Additionally, obesity has been associated with disrupted circadian rhythm, manifesting in abnormal sleeping and feeding patterns. To date, the mechanisms linking obesity, circadian disruption, and CVD are incompletely understood, and insight into novel mechanistic pathways is desperately needed to improve therapeutic potential and decrease morbidity and mortality. The objective of this study was to investigate the roles of metabolic and circadian disruptions in obesity and assess their contributions in promoting vascular disease. Lean (db/+) and obese (db/db) mice were subjected to 12 weeks of constant darkness to differentiate diurnal and circadian rhythms, and were assessed for changes in metabolism, gene expression, and vascular function. Expression of endothelial nitric oxide synthase (eNOS), an essential enzyme for vascular health, was blunted in obesity and correlated with the oscillatory loss of the novel regulator cezanne (OTUD7B). Lean mice subjected to constant darkness displayed marked reduction in vasodilatory capacity, while endothelial dysfunction of obese mice was not further compounded by diurnal insult. Endothelial gene expression of essential circadian clock components was altered in obesity, but imperfectly phenocopied in lean mice housed in constant darkness, suggesting overlapping but separate mechanisms driving endothelial dysfunction in obesity and circadian disruption. Taken together, these data provide insight into the nature of endothelial circadian rhythm in obesity and suggest a distinct mechanism by which obesity causes a unique circadian defect in the vasculature.

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