Normative values for circadian and ultradian cardiovascular rhythms in childhood.

ABSTRACT

To assess the prevalence and characteristics of physiological circadian (24-hour) and ultradian (12-, 8-, and 6-hour) rhythms of mean arterial blood pressure (BP) and heart rate (HR), we analyzed 24-hour ambulatory BP profiles from 938 healthy school children aged 5 to 18 years. Cosine harmonics were fitted by Fourier analysis, and an amplitude and acrophase (time of peak) were calculated for each rhythm. Ninety percent of children displayed circadian rhythmicity of BP, independent of age, whereas circadian HR rhythmicity decreased with puberty from 96% to 87% (P<0.0001). Puberty had marked effects on the prevalence of ultradian rhythmicity 12- and 6-hour rhythms increased for BP (27% to 47%, P<0.0001; 18% to 25%, P=0.01) and HR (36% to 47%, 17% to 31%, both P=0.001), whereas 8-hour BP rhythms decreased (34% to 23%, P=0.002). Median amplitudes were 10.1, 5.9, 5.6, and 5.2 mm Hg for the 24-, 12-, 8-, and 6-hour BP rhythms, respectively, and 13.4, 7.7, 6.8, and 6.4 bpm for HR. The acrophase occurred at approximately 1400 hours, 800 hours, 530 hours, and 200 hours (military time) for the four BP rhythms, and at 1330 hours, 0830 hours, 0150 hours, and 0200 hours for HR. For the combined curve, the peak-trough difference was 25.9 mm Hg and 35 bpm for BP and HR, respectively, with the peaks occurring at 1350 hours and 1310 hours. There was marked association between BP and HR rhythms, both for prevalence (P<0.0001 for coupling of BP and HR rhythms of the same period length) and timing, with a median time lag of BP after HR acrophase of only 21, 16, 13, and 5 minutes for the four rhythms, respectively.