Morning Surge and Variability in Blood Pressure

Abstract

Ambulatory blood pressure (BP) exhibits significant diurnal variation with modification of various psychological and physical stimulations during daily living.1 There is a consensus that the average ambulatory BP levels over 24 hours are more closely associated with hypertensive target organ damage and cardiovascular event than clinical BP.2 In addition, exaggerated ambulatory BP variation may be important in addition to the average BP level. However, results of previous studies that attempted to demonstrate the association between BP variability and cardiovascular disease are inconsistent. Some studies have found that ambulatory BP variability is a significant and independent determinant of target organ damage and poor cardiovascular prognosis,3,4 whereas others have not found an independent association.5 The reason for these inconsistent results is partly the modification of diurnal BP variation. Abnormal diurnal BP variation, such as marked nocturnal BP falls (extreme dippers) or the exaggerated morning BP surge, and reverse diurnal BP variation patterns with higher sleep BP than awake BP (risers) are risks for target organ damage and cardiovascular events.6–8 These phenotypes of ambulatory BP variability are associated partly with each other and with 24-hour ambulatory BP variability. Abnormal diurnal BP variability is associated with other relatively shorter BP variability, such as orthostatic BP variabilities in elderly hypertensives. In this issue, Zakopoulos …