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Navigating the waves: understanding blood pressure amplitude and rhythm changes from childhood to adulthood

Journal of Human Hypertension (2024)Cite this article

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The circadian rhythm regulates individuals’ blood pressure (BP) and heart rate. It is significantly linked with cardiovascular physiology and diseases. Any abnormalities in these rhythms may lead to sleep problems, several adverse cardiovascular events [1], cardiorenal outcomes and an increased risk of cardiovascular mortality [2]. This circadian mechanism such as awake or sleep, autonomic nervous system cycles and pineal gland melatonin synthesis are the factors regulating the 24-h BP profile [3]. Understanding their role could pave the way for tailored treatments targeting circadian BP dysregulation and hypertension [2].

Circadian rhythm of BP during childhood and adulthood is crucial for the early diagnosis of cardiovascular diseases and to avert complications [4]. As we traverse life from childhood to adulthood, our bodies undergo a remarkable symphony of changes. Among these transformations, the subtle yet important variability in BP rhythm amplitude and percent rhythm changes play a significant role in shaping our cardiovascular health. The rhythm amplitude of BP refers to the distance between the highest value of the cosine curve and the BP midline estimating statistic of rhythm (BP mesor) [5]. This BP rhythm amplitude represents the extent of range from the peak BP levels to the average BP level over 24 h. An elevated BP rhythm amplitude signifies substantial differences between the highest BP readings and the BP mesor over 24-h period. This condition is often associated with dipping BP pattern and lower nocturnal BP levels. In childhood, this rhythm amplitude undergoes a gradual refinement as the cardiovascular system matures. As age progresses, pulse amplitude increases impacting the carotid, radial and femoral arteries [6]. Children who are in the highest systolic and diastolic BP trajectories (i.e., high BP in the early period and remained elevated) had a significantly higher risk of developing elevated BP during early adulthood [7]. Similar to BP trajectories, BP rhythm amplitude also demonstrates the potential for predicting future hypertension and cardiovascular events [8]. These findings imply that BP during childhood and adolescence may predict the occurrence of elevated BP in adulthood. On the other hand, lower percent rhythm changes implicate a dampened rhythm of the heartbeat [9]. The heart’s rhythm is orchestrated by a delicate interplay of electrical signals, and during childhood, it undergoes a process of fine-tuning. The transition from childhood to adolescence is marked by a decrease in heart rate, reflecting the maturation of the cardiovascular system. This shift is indicative of a more efficient heart, capable of pumping blood with increased precision and less effort.

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Fig. 1: Schematic diagram of changes in BP rhythm amplitude from childhood to adulthood.

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Authors and Affiliations

  1. Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, Penang, Malaysia

    Nazar Mohd Azahar

  2. Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh, Sungai Buloh, Selangor, Malaysia

    Mohamad Rodi Isa

  3. NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Otsu, Japan

    Mizuki Ohashi

  4. Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan

    Yuichiro Yano

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  1. Nazar Mohd Azahar
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  2. Mohamad Rodi Isa
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  3. Mizuki Ohashi
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  4. Yuichiro Yano
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NMA wrote the draft of this editorial. NMA, MRI, MO, and YY contributed to manuscript review and editing, ensuring accuracy in data interpretation and presentation. All authors read and approved the final editorial.

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Correspondence to Nazar Mohd Azahar.

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Mohd Azahar, N., Isa, M.R., Ohashi, M. et al. Navigating the waves: understanding blood pressure amplitude and rhythm changes from childhood to adulthood. J Hum Hypertens (2024). https://doi.org/10.1038/s41371-024-00953-y

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