(PHILADELPHIA) - It has been known for decades that heart attacks and strokes occur most frequently in the early-morning hours. Now, researchers at the University of Pennsylvania School of Medicine have provided the first evidence for the role of our body's internal molecular clock in controlling blood pressure and a mechanism by which this occurs. Published online next week in the Proceedings of the National Academy of Sciences, this report points to the novel possibility of modifying blood pressure and the early-morning risk of heart attack.
The upswing in heart attacks tracks with rising blood pressure, which undergoes a 24-hour, or circadian, rhythm. This rise in blood pressure is amplified in patients with high blood pressure. However, scientists have debated as to whether this event signifies a role for the molecular clock, or merely reflects the relationship of clock time to stresses in our environment - such as awakening, hurried dressing, and the rush to work.
"This study provides evidence that integrates both explanations for the variation in blood pressure with clock time and, by inference, the daily variation in heart attack and stroke," explains first author and postdoctoral fellow Annie M. Curtis, PhD.
The molecular clock is a complex set of genes located in a discrete brain area that tightly regulate circadian rhythms in behavior, temperature, and metabolism. Researchers now appreciate that this "master clock" also interacts with clocks in almost all types of tissues.
Using mice in which the function of major clock genes have been disrupted, the investigators found distinct and complimentary effects on blood pressure and its circadian variation. What's more, genes relevant to the production and breakdown of catecholamines - the hormones that equip mammals for "fight and flight" behavior were under the control of the clock.
Catecholamines - norepinephrine and epinephrine - undergo a daily variation, but also rise in response to stress. The investigators wondered if they might provide a link between the two explanations for the early morning rise in heart attacks.
Using a mouse model in which catecholamines and blood pressure were made to surge, the researchers found that the rise in both blood pressure and catecholamines depended on the time of the stress. The greatest response occurred at a time that would correspond to the early morning hours in humans.
However, the greater surprise was yet to come, say the investigators. Deletion of a core clock gene completely abolished both the catecholamine and blood pressure response to stress, irrespective of when the stress was applied during the daily clock cycle. This effect was specific to the catecholamines, as the stress response of another hormone - a steroid - was unaltered.
"These results integrate for the first time the two leading explanations for the diurnal variation in blood pressure and reveal an unexpected role for a clock gene in regulating the stress response" says senior author Garret A. FitzGerald, MD, Director of the Institute for Translational Medicine and Therapeutics at Penn FitzGerald. "They raise the novel possibility of modifying blood pressure and consequently the early-morning risk of heart attack and stroke by using drugs to 'reset' the molecular clock." Since blood pressure response (via rising catecholamines) to stress in the early morning is tied to one's internal clock, tamping down the clock using drugs could be a treatment for people with high blood pressure, whose upswing in pressure is amplified in the morning anyway.
This study was funded by the National Institutes of Health. Co-authors in addition to FitzGerald are Anne M. Curtis, Yan Cheng, Shiv Kapoor, Dermot Reilly, Tom S. Price, all from Penn.
This release can be viewed at www.pennhealth.com/news.
PENN Medicine is a $2.9 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #3 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.
The University of Pennsylvania Health System includes three hospitals, all of which have received numerous national patient-care honors [Hospital of the University of Pennsylvania; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center]; a faculty practice; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.