Are melatonin and its receptor agonist specific antihypertensive modulators of resistant hypertension caused by disrupted circadian rhythm?

摘要

It is well-known that the onset of cardiovascular disease shows a circadian rhythm and that the incidence of cardiovascular events such as stroke and myocardial infarction increases in the early morning.1 Blood pressure also shows a circadian rhythm and it decreases by 10% to 20% during nocturnal sleep. This circadian rhythm in blood pressure is the result of modifications in the clock gene-regulated endogenous sleep-wake rhythm with a cardiovascular response to living environment-based mental and physical activities. Recently, it has become known that a disrupted circadian rhythm of blood pressure (ie, nondipper not showing a fall in the nocturnal blood pressure, or riser showing elevated nocturnal blood pressure) compared with the daytime blood pressure, on the contrary, is linked to a cardiovascular risk independent of a high blood pressure level. In addition, a relatively short-term abnormal change in blood pressure such as morning surge and sleep surge modifies the cardiovascular risk.