Targeting on Morning Blood Pressure Surge

Abstract

Morning blood pressure surge (MBPS) is an independent predictor of cardiovascular events. The most common definition of MBPS was a pre waking surge (mean blood pressure for 2 hours after wakeup minus mean blood pressure for 2 hours before wake-up). The sympathetic nervous system plays a major role in the regulation of BP variability. Asleep blood pressure has been shown to better reflect cardiovascular risk than awake BP in hypertensive patients. A possible link was found between disturbed sleep and MBPS. Exaggerated MBPS and increased low-grade inflammation independently increase the risk of stroke, while the relationship between exaggerated MBPS and the presence of silent cerebral infarct is slightly affected by low-grade inflammation. Furthermore, type 2 diabetes mellitus was an independent risk factor for increased MBPS. Serum uric acid, low density lipoprotein-cholesterol, anxiety disorder and so on may also involve in MBPS. Telmisartan was shown to normalize the circadian blood pressure pattern to a dipper profile in a larger proportion of patients than ramipril, and reduce early-morning systolic blood pressure surge in high-risk patients. Telmisartan alone or with HCTZ improved morning high blood pressure control and maintained a smooth high blood pressure profile throughout the day in a real-life setting. Furthermore, once-daily dosing of valsartan results in equally effective 24-hour blood pressure efficacy, regardless of dosing time. In total, future studies specifically designed to evaluate the real impact of MBPS on outcomes, as well as to define its optimal cutoff value, are required.