To dip or not to dip: on the physiology of blood pressure decrease during nocturnal sleep in healthy humans

Hypertension. 2007 May;49(5):1070-6. doi: 10.1161/HYPERTENSIONAHA.106.084343. Epub 2007 Mar 12.


That sleep is accompanied by a blood pressure decrease is well known; however, the underlying physiology deserves further investigation. The present study examines in healthy subjects 2 main questions: is this dipping actively evoked? and what are the consequences of nondipping for daytime blood pressure? Nocturnal blood pressure was extrinsically elevated in 12 sleeping subjects to mean daytime values by continuously infused phenylephrine. This nondipping significantly lowered morning blood pressure during rest and 3 hours after resuming physical activity compared with a control condition (isotonic saline). Neither muscle sympathetic nerve activity nor sensitivity of alpha-adrenoceptors was reduced. However, the set point for initiation of regulatory responses through the baroreflex was clearly shifted toward lower blood pressure levels. Our results support the hypothesis of an actively regulated central mechanism for blood pressure resetting and set point consolidation of the baroreflex during nighttime sleep. This is suggested by the fact that extrinsically induced nondipping induces sustained decrease in blood pressure during the following morning through an actively lowered baroreflex set point.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiotensin II / blood
  • Baroreflex / physiology
  • Blood Pressure / drug effects
  • Blood Pressure / physiology*
  • Blood Pressure Monitoring, Ambulatory
  • Circadian Rhythm*
  • Drug Administration Schedule
  • Female
  • Heart Rate / physiology
  • Humans
  • Infusion Pumps
  • Male
  • Nitroprusside / pharmacology
  • Phenylephrine / administration & dosage
  • Phenylephrine / pharmacology
  • Reference Values
  • Renin / blood
  • Single-Blind Method
  • Sleep / physiology*
  • Vasoconstrictor Agents / administration & dosage
  • Vasoconstrictor Agents / pharmacology
  • Vasodilator Agents / pharmacology


  • Vasoconstrictor Agents
  • Vasodilator Agents
  • Angiotensin II
  • Nitroprusside
  • Phenylephrine
  • Renin