EARLY MORNING SURGE BLOOD PRESSURE AND ISOLATED SYSTOLIC HYPERTENSION - A CLINICAL IMPORTANCE IN ELDERLY

Abstract

Objective: In hypertensive patients treated with antihypertensive medication, even patients whose clinic blood pressure is well controlled, morning blood pressure prior taking medication remains high, and therefore morning hypertension is currently the blind spot in the clinical practice of hypertension. To objective is to asses now again on a wider group of patients whether an increased early morning blood pressure surge is related to more prominent target organ damage. Design and method: 623 treated hypertensive patients randomly attended the out-patient clinic of our hypertension centre from 6 October 2009 to 1 November 2014, and supplemented from 2 November 2014 to 31 October 2016. The Isolated Systolic Hypertension patients (n = 176, 78 ± 11 yrs) were divided into 2 groups (n = 176 {with morning hypertension [sleep > 120mmHg] n = 140 [nondippers] and those without n = 36 [dippers]}). Early Morning Blood Pressure Surge, was defined as peak Blood Pressure during morning period (4–6am, average of 5 values, mean = 124.19 mmHg, SD 21.91 mmHg) minus average BP during the sleep period (average of lowest 3 sleep values, mean = 145.49 mmHg, SD 22.14 mmHg). Early morning surge had a mean of 22.78 mmHg, SD 11.92 mmHg, (P < 0.01). Pulse Pressure was also used in this study as a direct predictor of hypertensive target organ damage. Results: Nondipping pattern is related to metabolic syndrome, masked hypertension and female gender. Pulse pressure mean was higher in Nondippers by 11mmHg. Higher cases of stroke and MI where reported in the Early Morning Surge group. Conclusions: Early Morning Surge is a predictor of hypertensive target organ damage.