Circadian regulation of cardiovascular function: from physiology to clinical implications

Circadian rhythms play a crucial role in maintaining cardiovascular homeostasis, orchestrating fluctuations in blood pressure, heart rate variability, endothelial function, and systemic vascular tone. Disruptions of the circadian clock -arising from ageing, genetic predisposition, or environmental and lifestyle factors- can significantly elevate the risk of cardiovascular diseases, including hypertension, atherosclerosis, heart failure, and arrhythmias. This review examines the role of circadian regulation in cardiovascular physiology, from molecular clock networks and clock-controlled gene regulation to systemic cardiovascular physiology and clinical translation. We discuss how circadian disruption affects blood pressure, heart rate variability, and vascular health, through mechanisms including inflammation, mitochondrial dysfunction, and metabolic dysregulation. We further position circadian biology within the broader context of cardiovascular ageing and the molecular mechanisms that drive age-associated cardiovascular decline.Special attention is given to the role of inflamm-ageing in promoting atherosclerosis and acute cardiovascular events, as well as the impact of desynchrony between central and peripheral clocks on disease severity. Additionally, we highlight the circadian regulation of genes implicated in cardiovascular ageing and disease. Finally, we explore emerging research on the clinical implications of circadian misalignment, with a focus on therapeutic strategies such as chronotherapy, time-restricted eating, and physical activity. By integrating current evidence, this review provides a comprehensive perspective on leveraging circadian rhythms for the prevention and management of cardiovascular diseases.