Morning Blood Pressure Levels Research Articles

The HOPE Asia network 2022 up-date consensus statement on morning hypertension management.

Morning hypertension is an important clinical target in the management of hypertension for perfect 24‐h blood pressure (BP) control. Morning hypertension is generally categorized into two types: “morning surge” type and “sustained nocturnal and morning hypertension” type. The “morning surge” type is characterized by an exaggerated morning blood pressure surge (MBPS), and the “sustained nocturnal and morning hypertension” type with continuous hypertension from nighttime to morning (non‐dipper/riser type). They can be detected by home and ambulatory blood pressure measurements (HBPM and ABPM). These two forms of morning hypertension both increase the risk of cardiovascular and renal diseases, but may occur via different pathogenic mechanisms and are associated with different conditions. Morning hypertension should be treated to achieve a morning BP level of < 135/85 mmHg, regardless of the office BP. The second target morning BP levels is < 125/75 mmHg for high‐risk patients with morning hypertension and concomitant diseases. Morning hypertension is more frequently found in Asians, than in Westerners. Thus, the management of morning hypertension is especially important in Asia. The detection of morning hypertension and the individual home BP‐guided treatment approach targeting morning BP in combination with ABPM, and the optimal treatment of morning hypertension would reduce cardiovascular events in Asia.

Bedtime administration of antihypertensive medication can reduce morning blood pressure surges in hypertensive patients: a systematic review and meta-analysis.

The risk of cardiovascular and cerebrovascular events is the highest during the first several hours post-awakening in patients with hypertension. This is largely due to surges in morning blood pressure (BP). The current meta-analysis explored whether morning BP is affected by the timing of antihypertensive drug administration. Four medical databases were searched for clinical trials that examined the relationship between the timing of antihypertensive drug administration and morning BP levels. This meta-analysis compared morning BP surges in patients administered medication at bedtime versus patients administered medication during the day. The random effects model demonstrated that bedtime administration of antihypertensive drugs reduced morning systolic blood pressure (SBP) by 1.17 mmHg [with 95% confidence interval (CI): -2.47 to 0.37; P=0.08), and reduced morning diastolic blood pressure (DBP) by 0.95 mmHg (95% CI: -2.03 to 0.13; P=0.08), compared with patients who were administered medication during the daytime hours. However, the results did not demonstrate statistical significance. There was strong heterogeneity in both morning SBP (I2 =77.9% >50%, and Q test >0.1) and morning DBP results (I2 =77.9% >50%, and Q test >0.1). The funnel plots showed no publication bias in this study. Studies have shown that a 1 mmHg change was sufficient to reduce the risk of cardiovascular-related deaths by 2.1%. Therefore, changing the time of taking antihypertensive medications may significantly reduce cardiovascular-associated mortality. There were certain limitations to this meta-analysis. First, the heterogeneity of the meta-analysis was strong, with undefined reasons. Second, the sample size was relatively small, and future studies involving larger cohorts are warranted to further assess the effects of bedtime antihypertensive medication on minimizing morning BP surges.

Comparative analysis of several methods for blood pressure measurement in the morning in patients with arterial hypertension

Aim. To compare the known methods of blood pressure (BP) measurement in the morning and a new method for estimating the average morning BP for fixed time intervals, comparing their reproducibility and validity.Material and methods. We analyzed database containing 983 cases of ambulatory blood pressure monitoring (ABPM). Results of ABMP in patients with hypertension without severe associated diseases and weekly cancellation of antihypertensive therapy were analyzed. Blood pressure data per 24-hour period, day and night, level and rate of morning BP surge were assessed. In addition, we proposed new method for estimating the average morning BP level for fixed time intervals, based on calculating the average BP level for the following time windows: from 5:00 to 7:00 a.m., from 7:00 to 9:00 a.m., from 9:00 to 11:00 a.m. To assess the reproducibility of the new method, we determined correlations between the first and second group results calculated by the new method based on two repeated ABPM conducted with 1-2 weeks interval (n=90). To study the validity of the new method for measurement of average morning BP level, we used an objective validation criterion — Left Ventricular Myocardium Mass Index (LVMMI). There were performed 98 echocardiographic tests with the use of Acuson 128XP. LVMMI was calculated using the L. Teichholtz method (1976).Results. The new method for measurement of average morning BP level had good reproducibility while the reproducibility of dynamic showings of ABMP (level and rate of morning BP surge) was low. A new method for assessing morning blood pressure was characterized by a high level of validity: the indicators obtained using this technique reliably correlated with the validation criteria: LVMI and the average daily blood pressure level.Conclusion. The proposed new method for estimating the average morning level of blood pressure has a high level of validity and reproducibility. Time interval from 7 to 9 a. m. seems to be the most optimal. The maximum reproducibility of the showings was noted during this period.

Influence of Alcohol Intake on Circadian Blood Pressure Variation in Japanese Men: The Ohasama Study

Both a large habitual alcohol intake and a pattern of circadian blood pressure (BP) variation characterized by a high morning/daytime BP have been reported to be risk factors for cerebral hemorrhage. Therefore, the association between these two factors was examined. A total of 194 men in the general population of Ohasama underwent ambulatory BP measurement, completed a lifestyle questionnaire, and were classified into three categories according to current alcohol consumption: nondrinkers, light drinkers, and heavy drinkers. Two-hour moving averages of BP (2h-BP) were used to compare BP variation during a 24-h period among the drinking categories. 2h-BP Dif (defined as 2h-BP 2 h after waking minus 2h-BP 2 h before waking) and the percentage decline in nocturnal BP were also assessed as indicators of circadian BP variation. Multivariate analysis was conducted after adjustment for possible confounding factors including daily salt intake. Analysis of 2h-BP revealed that BP variation in drinkers had specific characteristics: a rapid BP increase before waking and higher morning BP levels (P = 0.0001). 2h-BP Dif was significantly higher in heavy drinkers than in nondrinkers (P = 0.04), while there was no significant association between drinking status and the magnitude of the nocturnal BP decline. Habitual alcohol intake was associated with a higher 2h-BP Dif.

Factors Associated with Baroreflex Sensitivity: Association with Morning Blood Pressure

Baroreflex sensitivity (BRS) is a primary mechanism for acute and chronic control of blood pressure (BP). However, there are few data showing the relationship between BRS and ambulatory BP (ABP). We assessed the hypothesis that BRS specifically contributes to some specific parameters of ABP in never-treated hypertensive/normotensive subjects. We studied 128 subjects (mean age: 54.5+/-13 years, 60% male) consisting of 92 untreated hypertensive and 36 normotensive subjects. Radial tonometric BP and simultaneous RR interval were recorded for 10 min, and the Valsalva maneuver was performed 3 times for each subject. BRS was calculated in two ways: the spontaneous-BRS by the spectral method, and the Valsalva-BRS by the slope method, using commercial software. ABP monitoring was performed on the same day as the BRS test. Of 128 subjects, we obtained BRS from 111 subjects with the Valsalva method and 123 subjects with the spontaneous method. Univariate analyses showed that the Valsalva-BRS was negatively correlated only with morning systolic BP (r=-0.21, p=0.03). Multivariable analyses showed that the Valsalva-BRS (ms/mmHg) was independently associated with the morning systolic BP (beta=-0.26, p=0.022), even after adjusting for age, sex, body mass index, presence of diabetes, duration of hypertension, clinic systolic BP and pulse rates. The spontaneous-BRS estimates were inversely correlated with clinic pulse rates in the same model. In conclusion, impaired BRS evaluated by the Valsalva method was associated with high morning BP level, independent of other confounders. Morning hypertension might be partly mediated by impaired BRS.