(Hypertension. 1999;34:685-691.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
Ambulatory Physical Activity as a Determinant of Diurnal Blood Pressure Variation
From the Hypertension Center (K.K., J.E.S., T.G.P.), Weill Medical College of Cornell University, New York Presbyterian Hospital, NY; and the Department of Psychiatry (J.E.S.), State University of New York–Stony Brook, NY.
Correspondence to Kazuomi Kario, MD, PhD, or Joseph E. Schwartz, PhD, Hypertension Center, Department of Medicine, Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10021.
Abstract—There are reports that
indicate that diurnal blood pressure (BP) variation, in addition to
high BP per se, is related to target organ damage and the incidence of
cardiovascular events. However, the determinants of
diurnal BP variation are not adequately understood. We used actigraphy
and ambulatory BP monitoring to study the diurnal variation of BP and
physical activity in 160 adults. Within individuals, activity was more
strongly related to pulse rate than to BP. The correlation between BP
and activity was stronger during sleep than when awake, but the
correlation between activity and pulse rate was higher during the awake
period than during sleep. Between individuals, the sleep/awake ratio of
systolic BP (SBP) was correlated with mean sleep activity
(r=.17, P<0.05), mean awake activity
(r=-0.16, P<0.05), and, especially, the
ratio of sleep/awake activity (r=.24,
P<0.01). Awake BP variability (SD of awake SBP) was
positively correlated with awake activity (r=.16,
P<0.05). In regard to the effect of position, the
standing-supine SBP difference was negatively correlated with the
sleep/awake SBP ratio (r=-0.39, P<0.01)
and positively correlated with awake SBP variability
(r=.33, P<0.01). When we divided the
subjects into 3 groups, 19 extreme dippers (with a sleep SBP decrease
of 
20% of awake SBP), 102 dippers (with decreases of 10% to
<20%), and 39 nondippers (with decreases of <10%), no significant
differences existed in awake activity among the groups. However, the
nondippers exhibited greater sleep activity than extreme dippers
(P<0.05) and an increased sleep/awake activity ratio
compared with extreme dippers and dippers (P<0.01).
Extreme dipping may also be associated with increased BP variability
(P=0.08). Individual SBP responses to activity (the
within-person slope of awake SBP regressed on activity) did not differ
significantly among the 3 subgroups. In conclusion, physical activity
is one of the determinants of ambulatory BP and its diurnal variation.
We hypothesize that the association of sleep activity to sleep BP and
dipping reflects differences in sleep quality.
Key Words: blood pressure • exercise • sleep • position • extreme dipper • nondipper
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