Morning Surge In Systolic Blood Pressure Research Articles

High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy

We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.

Effect of renal denervation in attenuating the stress of morning surge in blood pressure: post-hoc analysis from the SPYRAL HTN-ON MED trial

Catheter-based renal denervation (RDN) reduces blood pressure (BP) throughout the 24-h period, as reported in several randomized sham-controlled trials. Reduction of BP in the early morning hours is especially important due to increased cardiovascular risks during that time. In this report, we examine the impact of RDN on systolic BP (SBP) and diastolic BP (DBP) during the critical morning surge period in a post-hoc analysis of patients in the SPYRAL HTN-ON MED trial. Ambulatory BP measurements were collected at baseline and 6months for treatment and control patient groups over 24-h periods. Average morning BP surge is the difference between average morning BP and average nighttime BP, and the morning surge slope reflects the rate of change of BP from nighttime to morning. Mean morning DBP surge slopes were significantly lower for RDN vs. control groups at 6months (1.1 vs. 3.6mmHg/h; p = 0.029). In the RDN group, morning DBP surge slopes were significantly lower at 6months compared to baseline (1.1 vs. 4.1mmHg/h; p = 0.006). Similar patterns were observed for mean morning SBP surge slope but did not reach statistical significance. This decrease in the morning DBP surge slope, an index of the sympathetically-mediated morning BP surge, thus indicates a drop in late morning BP relative to early morning/nocturnal BP in the RDN group. Thus, RDN appears effective in attenuating the slope of morning surge in DBP that might indicate possible benefits in a high-risk hypertensive population. https://www.clinicaltrials.gov (NCT02439775), registered May 12, 2015.

Morning Blood Pressure Surge and Cardiovascular Disease Events and All-Cause Mortality in Blacks: The Jackson Heart Study.

The cardiovascular disease (CVD) and mortality risk associated with morning blood pressure (BP) surge and its components among black adults, a population with high BP during the asleep period, is unknown. We studied Jackson Heart Study participants who completed 24-hour ambulatory BP monitoring at the baseline exam in 2000 to 2004 (n=761). The sleep-trough morning surge was calculated as the mean 2-hour postawakening systolic BP (SBP) minus the lowest nighttime SBP, preawakening morning surge as mean 2-hour postawakening SBP minus mean 2-hour preawakening SBP, and rising morning surge as the first postawakening SBP minus the last preawakening SBP. The primary outcome was the occurrence of CVD events including the composite of coronary heart disease or stroke. Over a median follow-up of 14.0 years, there were 74 CVD (coronary heart disease or stroke) events and 144 deaths. Higher tertiles of sleep-trough, preawakening, and rising SBP surge were not associated with CVD risk after multivariable adjustment. In contrast, the highest tertile of the individual components of morning surge, including postawakening SBP (tertiles 2 and 3 versus 1: hazard ratio [95% CI]: 1.58 [0.71-3.53] and 4.04 [1.91-8.52], respectively), lowest nighttime SBP (1.29 [0.59-2.84] and 2.87 [1.41-5.83]), preawakening SBP (1.26 [0.57-2.80] and 2.79 [1.32-5.93]), first postawakening SBP (1.60 [0.73-3.51] and 2.93 [1.40-6.16]), and last preawakening SBP (1.23 [0.57-2.68] and 2.99 [1.46-6.12]), was associated with increased CVD risk after multivariable adjustment. Among black adults, the components of morning SBP surge, but not morning SBP surge itself, were associated with increased CVD risk.

Winter morning surge in blood pressure after the Great East Japan Earthquake.

This study investigated the association between winter morning surge in systolic blood pressure (SBP) as measured by ambulatory BP monitoring and the housing conditions of subjects in an area damaged by the Great East Japan Earthquake. In 2013, 2years after disaster, hypertensives who lived in homes that they had purchased before the disaster (n=299, 74.6±8.1years) showed significant winter morning surge in SBP (+5.0±20.8mmHg, P<0.001), while those who lived in temporary housing (n=113, 76.2±7.6years) did not. When we divided the winter morning surge in SBP into quintiles, the factors of age ≥75years and occupant-owned housing were significant determinants for the highest quintile (≥20mmHg) after adjustment for covariates. The hypertensives aged ≥75years who lived in their own homes showed a significant risk for the highest quintile (odds ratio 5.21, 95% confidence interval 1.49-18.22, P=0.010). It is thus crucial to prepare suitable housing conditions for elderly hypertensives following a disaster.

Association of Circadian Rhythm of Blood Pressure and Cerebral Small Vessel Disease in Community-Based Elderly Population.

Although it is accepted that the etiology of cerebral small vessel disease (CSVD) is associated with cardiovascular risk factors, the association between CSVD and the circadian rhythm of blood pressure (BP) is unclear. We aimed to determine if such an association existed in the elderly population. White matter hyperintensities (WMHs), lacunes, microbleeds, nocturnal dipping pattern (NDP), and morning surge in systolic blood pressure (SBP) were assessed in 2,091 participants ≥60 years of age. During an average of 63 months of follow-up, WMH and the WMH-to-intracranial volume ratio were significantly increased in extreme dippers, nondippers, and reverse dippers than those in dippers (p < .001). For new-incident Fazekas scale ≥2, the hazard ratios were 1.77 (95% confidence interval [CI], 1.09-2.86) for extreme dippers, 2.20 (95% CI, 1.48-3.28) for nondippers, and 2.43 (95% CI, 1.59-3.70) for reverse dippers compared with dippers, and 1.04 (95% CI, 0.81-1.35) for higher morning surge compared with lower morning surge. Nondippers and reverse dippers were associated with higher risks of new-incident lacunes and microbleeds than dippers (p < .05). Higher morning surge was associated with a higher risk of new-incident microbleeds than lower morning surge (p < .05). NDPs in SBP played an important role in CSVD, and the morning surge in SBP was associated with cerebral microbleeds in community-based elderly population beyond the average SBP level.

Abstract P170: Morning Surge and Cardiovascular Events in African Americans: The Jackson Heart Study

Introduction: A larger sleep-trough morning surge, defined as the mean two-hour post-awakening blood pressure (BP) minus the lowest asleep BP, has been associated with cardiovascular disease (CVD) events in Asians and Europeans. High asleep BP in African Americans (AA) may preclude a morning surge and an association with CVD due to a smaller BP change upon awakening. Objective: Determine the association of morning surge with CVD events in AAs. Methods: We analyzed participants from the Jackson Heart Study, a community-based cohort of AAs, with a complete 24-hour ambulatory BP monitoring recording and self-report asleep and awake times at baseline in 2000-2004 (n=767). Participants were grouped into tertiles of sleep-trough morning surge, two-hour post-awakening BP and lowest sleep BP. CVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or fatal coronary heart disease; n=61) through December 2012 were adjudicated. Results: Participants’ mean age was 59.2 years and 32.1% were male. Multivariable adjusted hazard ratios (95% CI) for CVD events associated with Tertile 2 and 3 versus Tertile 1 of morning systolic BP (SBP) surge were 1.45 (0.71 – 2.97) and 2.03 (0.98 – 4.23), respectively; of post-awakening SBP were 2.01 (0.81 – 4.99) and 4.41 (1.85 – 10.50), respectively; and of lowest asleep SBP were 1.55 (0.68 – 3.52) and 2.22 (0.96 – 5.14), respectively ( Table ). Also, there was a graded increasing risk for CVD associated with Tertile 2 and 3 versus Tertile 1 of post-awakening diastolic BP (DBP), but not morning DBP surge and lowest asleep DBP. Conclusion: Higher morning SBP surge, post-awakening SBP and lowest asleep SBP and DBP were associated increased CVD risk in AAs.

Morning surge in blood pressure and sympathetic activity in Mongolians and Han Chinese: a multimodality investigation of hypertension and dyssomnia.

BackgroundHypertension and dyssomnia are increasing significantly in Mongolians, and the related factors of ethnic differences in hypertension and dyssomnia between Mongolians and Han Chinese are unclear. This study examined the relationship of morning surge in blood pressure (MBP) with ethnicity, sleep situation, and sympathetic activity throughout the day.MethodsOf 692 hypertensive patients screened, 202 subjects with dyssomnia were selected. They were then divided into Mongolian (n = 87) and Han (n = 115) groups. The differences in dyssomnia, 24-h blood pressure, and urinary catecholamine were analyzed in all subjects; they were then further divided according to the degree of dyssomnia (low, moderate, and severe) to determine the differences in blood pressure and catecholamine.ResultsMongolians had a lower history of smoking, daytime dysfunction, nocturnal heart rates, and dopamine levels, but their body mass index, triglyceride, fasting glucose, morning surge in systolic blood pressure (MSBP), nocturnal systolic blood pressure (NSBP), nocturnal diastolic blood pressure, daytime systolic blood pressure, daytime heart rates, and dopamine level (D-DA) were higher than those of Han Chinese. With the aggravation of dyssomnia, MSBP, NSBP, D-NE, daytime epinephrine, and D-DA of Mongolians and Han Chinese increased gradually, but the rate of increase was faster in the latter (p < 0.05). D-DA was entered into the MSBP regression model of Mongolians (intercept, 157 mmHg), whereas D-DA and D-NE were entered into the MSBP regression model of Han Chinese (intercept, 142 mmHg).ConclusionWorsened dyssomnia induces higher MSBP and augments sympathetic excitability in Mongolians and Han Chinese. Mongolians with hypertension and dyssomnia had higher MSBP baseline and D-DA but lower N-DA. With an increase in D-DA, MSBP in Han and Mongolian patients increased gradually.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION: VASCULAR WALL AS THE TARGET ORGAN IN COMORBID PATIENTS

Studies of endothelial dysfunction in patients with respiratory diseases have become relevant in recent years. Perhaps endothelial dysfunction and high arterial stiffness bind bronchopulmonary and cardiovascular diseases. Aim . To reveal features of disturbances of arterial wall vasoregulatory function in patients with chronic obstructive pulmonary disease (COPD) in the presence and absence of arterial hypertension (HT). Material and methods . The study included 50 patients with COPD with normal blood pressure (BP) and 85 patients with COPD and HT. Control group was presented by 20 practically healthy men comparable in age with COPD patients. Tests with reactive hyperemia (endothelium-dependent dilation) and nitroglycerin (endothelium-independent dilation) were performed in order to evaluate endothelium function. The number of desquamated endotheliocytes in the blood was determined. Results . In patients with COPD and HT in comparison with COPD patients without HT and healthy individuals more pronounced damages of the vascular wall, endothelium vasoregulatory function disturbances and a tendency to the reduction in endothelium-dependent vasodilation were determined both during COPD exacerbation and remission. These differences were most pronounced during the COPD exacerbation. In patients with COPD and HT in comparison with COPD patients without HT the damage of the vascular wall was more pronounced during the remission and endothelium-dependent dilatation disorder – during the exacerbation. The revealed disorders in patients with COPD and HT were associated with smoking status (r=0.61, p<0.01), severity of bronchial obstruction (r=-0.49, p<0.05), and hypoxemia (r=-0.76, p<0.01). We noted relationships between the parameters of 24-hour BP monitoring and remodeling of the brachial artery (r=0.34, p<0.05), endothelium lesion (r=0.25, p<0.05), and impairment of its vasoregulating function (r=-0.58, p<0.05). At that, the following parameters were important: the average systolic and diastolic BP levels, the BP load and variability indices, the time and rate of morning surge in systolic BP, and the circadian rhythm of BP. Conclusion . The obtained data show the aggravation of the severity of the vascular wall damages and the reduction in the endothelium vasoregulating activity in patients with COPD after development systemic HT. This effect is more evident during the exacerbation of bronchopulmonary disease.

Main features of the ambulatory blood pressure monitoring in the non-controlled essential hypertension patients

The problem of blood pressure (BP) effective control in Ukrainians is still relevant. Ambulatory blood pressure monitoring (ABPM) is a modern method of BP investigation. However, only some ABPM parameters, as diurnal systolic BP (SBP) and diastolic BP (DBP), now use as the diagnostic guide according to international recommendations.Aim. To determine peculiarities of ABPM parameters in treated uncontrolled hypertensive patients.Materials and methods. We investigated 153 patients with essential hypertension and divided two groups according to the level of 24-h SBP and 24-h DBP. There were 103 patients who have uncontrolled levels of BP in the first group and 50 patients with normotensive individuals in the second group.Results. We had a significant increase of SBP (21,8%; р=0,001), DBP (21,5%; р=0,001), pulse BP (PBP) (22,8%; р=0,001) and the morning surge in SBP (20,7%; р=0,004) in the first group versus the second group. Furthermore, there was a considerable rise in such parameters, like the square of hypertension of diurnal SBP in 9,2 times (р=0,001), daily in 9,5 times (р=0,001), nocturnal in 8,6 times (р=0,001); index of the square of diurnal DBP reduction in 7,2 times (р=0,001), daily in 8,1 times (р=0,001) and nocturnal in 5,7 times (р=0,001) in the first group than in the second group. There was no significant difference in index of night reduce of SBP, speed of morning rise of SBP and DBP, ambulatory arterial stiffness index (AASI) and symmetric slope index (sym_AASI).Conclusion. This study shows that treated non-controlled hypertensive patients have 20-25% increase in diurnal SBP, DBP and PBP. There is a night-fold increase in diurnal index of SBP square hypertension and a DPB seven-fold increase in diurnal index of square hypertension. There is no statistical significance in index of night reduce of SBP, speed of morning rise of SBP and DBP, AASI and sym_AASI.

PS 11-41 ASSOCIATION BETWEEN BODY MASS INDEX AND MORNING SURGE IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Obesity is an important risk factor for cardiovascular events via impaired glucose and lipid metabolisms and hypertension. Exaggerated morning blood pressure (BP) surge is also a risk for cardiovascular events. Although it is anticipated that obesity is associated with increased morning BP surge, this issue has not been fully investigated. In the present study, therefore, association between body mass index (BMI) and morning surge were investigated in patients with essential hypertension. Design and Method: Ambulatory BP monitoring (ABPM) was performed with an automatic device, TM-2431 (A&D, Tokyo, Japan) in patients with essential hypertension, and the morning surge in systolic BP was calculated by subtracting the 2-h average systolic BP before waking from the 2-h average systolic BP after waking. In addition, association between BMI and morning surge were investigated. Results: A total of 300 patients (135 males) were enrolled. The mean value for age was 57 ± 14 y.o., BMI 24.9 ± 4.6 kg/m2, triglyceride 146 ± 108 mg/dl, morning surge 16 ± 21 mmHg, and estimated glomerular filtration rate (eGFR) 75.3 ± 20.3 ml/min/1.73 m2. Morning surge showed significantly positive relationships with BMI (r = 0.329, p = 0.001), triglyceride (r = 0.233, p = 0.016), and eGFR (r = 0.204, p = 0.016) and significantly negative relationship with age (r = −0.312, p = 0.001). Multiple regression analysis testing age, gender, BMI, triglyceride, and eGFR as independent variables revealed that only BMI was significantly positively associated with morning surge (ß = 0.217, p = 0.036). Conclusions: High BMI was shown to be independently associated with increased morning BP surge. These data may suggest that morning BP surge is contributing, at least in part, to the high risk of cardiovascular evens in patients with obesity and hypertension. It is advisable that morning surge should be evaluated in these patients.

Morning Blood Pressure Surge, Dipping, and Risk of Coronary Events in Elderly Treated Hypertensive Patients.

The independent prognostic significance of morning surge (MS) of blood pressure (BP) is not yet clear. We investigated the association between MS of systolic BP and risk of coronary events in elderly treated hypertensive patients. The occurrence of coronary events was evaluated in 1,191 elderly treated hypertensive patients (age range 60-90 years). Subjects were divided according to tertiles of MS of systolic BP of the population as a whole, by dipping status and by group-specific tertiles of MS of systolic BP in dippers and nondippers. During the follow-up (9.1 ± 4.9 years, range 0.4-20 years), 120 coronary events occurred. In the population as a whole, coronary event risk was not significantly associated with tertiles of MS of systolic BP, whereas nondippers were at higher risk than dippers. When nondippers and dippers were analyzed separately, by group-specific tertiles of MS of systolic BP, coronary event risk was associated with MS of systolic BP in dippers but not in nondippers. After adjustment for various covariates, Cox regression analysis showed that dippers in the third tertile (>23 mm Hg) of MS of systolic BP (hazard ratio 1.912, 95% confidence interval 1.048-3.488, P = 0.03) and nondippers (hazard ratio 1.739, 95% confidence interval 1.074-2.815, P = 0.02) were at higher coronary event risk than dippers with MS of systolic BP <23 mm Hg . In elderly treated hypertensive patients, high MS of systolic BP predicts coronary events in dippers but not in nondippers. Nondippers, however, show higher risk of coronary events independently of MS in systolic BP.

Relationship among morning blood pressure surge, 24-hour blood pressure variability, and cardiovascular outcomes in a white population.

Cardiovascular events have their greatest prevalence in the early morning period. Whether this is attributable to an arousal-dependent blood pressure (BP) increase is far from being clear. It is also not clear to what extent this phenomenon reflects overall 24-hour BP variability. In 2051 subjects (aged 25-74 years) representative of the population of Monza (Italy), we measured 24-hour ambulatory systolic BP (SBP) and calculated the difference between the 2-hour average values after morning arousal and the lowest 3 or average 2-hour values before arousal (morning BP surge 1 and 2, respectively). For either measure, we sought the relationship with a variety of indices of 24-hour SBP variability and collected information on (1) the occurrence of cardiovascular and all cause deaths during a follow-up of ≈16 years and (2) the appearance of echocardiographic left ventricular hypertrophy after 10 years from the baseline visit. Morning SBP surge 1 was directly related to indices of 24-hour SBP variability, including those made independent on the magnitude of the day-night SBP difference. There was a weak positive relationship between morning SBP surge 1 and the risk of cardiovascular and all-cause death, which disappeared after adjustment for confounders. This was the case also for development of left ventricular hypertrophy. Morning SBP surge 2 was smaller, inconsistently related to 24-hour SBP variability and not at all related to fatal events or new-onset left ventricular hypertrophy. In a white population, morning BP surge was not found to be an independent predictor of cardiovascular death, all-cause death, or development of high cardiovascular risk (as documented by new-onset cardiac damage) even when appropriately assessed by measures that reflect its association with 24-hour BP variability.

Blood pressure variability and morning blood pressure surge in elderly Chinese hypertensive patients.

This retrospective study aimed to investigate blood pressure variability (BPV), morning systolic blood pressure surge (MBPS), and the associated factors in 513 elderly (65years and older) and 188 younger (younger than 65years) hypertensive Chinese patients who had ambulatory blood pressure monitoring (ABPM) at our hospital from January 1, 2002, to December 31, 2010. The MBPS was lower in the younger patients compared with the elderly patients, and it was highest in the 75 years and older and younger than 80 group (29.0±13.4mm Hg). Compared with other groups, the 80 years and older group had a significant increase in BPV (P<.05). Multiple linear regression analysis showed that body mass index (BMI; P<.01), up to 50years of smoking (P≤.03), and circadian blood pressure variation (P<.01) were factors associated with MPBS. In summary, systolic BPV and MBPS were increased in elderly Chinese hypertensive patients, and the MBPS was associated with BMI, years of smoking, and circadian blood pressure variation.

Effect of telmisartan vs. ramipril on ‘dipping’ status and blood pressure variability: pooled analysis of the PRISMA studies

A retrospective pooled analysis of the 'Prospective, Randomized Investigation of the Safety and Efficacy of MICARDIS vs. Ramipril Using ABPM' studies conducted in Europe and South Africa (PRISMA I) and in the United States of America and Canada (PRISMA II) was carried out to investigate the effects of telmisartan and ramipril on dipper status (extreme dippers, dippers, non-dippers, risers/reverse dippers), and blood pressure (BP) variability in 1279 patients (with normal sleeping patterns and valid 24-h ambulatory BP monitoring recordings at baseline and end point). After 14 weeks' treatment, telmisartan had a greater systolic BP (SBP) reduction and higher smoothness index in all four dipper groups compared with ramipril. In addition, the tendency toward dipping was significantly higher in patients treated with) telmisartan than ramipril (P=0.032; odds ratio for telmisartan vs. ramipril: 1.27 (95% confidence interval: 1.102-1.58)). In patients with an early morning SBP surge 35 mm Hg, telmisartan treatment was associated with significantly greater reductions from baseline in the night-time low mean, early morning mean and early morning SBP surge compared with ramipril (P=0.026, P<0.0001 and P=0.0006, respectively). In this retrospective analysis, telmisartan was shown to normalize the circadian BP pattern to a dipper profile in a larger proportion of patients than ramipril, and reduce early-morning SBP surge in high-risk patients, indicative of a cardioprotective effect. These findings need to be confirmed in long-term prospective trials and observational studies.

Morning Blood Pressure Surge, Dipping, and Risk of Ischemic Stroke in Elderly Patients Treated for Hypertension

The independent prognostic significance of morning surge (MS) in blood pressure (BP) is not yet clear. We investigated the association between MS in systolic BP (SBP) and risk of ischemic stroke in elderly patients treated for hypertension. Occurrence of ischemic stroke was evaluated in 1,191 elderly patients treated for hypertension (aged 60-90 years). Patients were divided according to tertiles of MS in SBP in the population as a whole, dipping status, and group-specific tertiles of MS in SBP in dippers and nondippers. During follow-up (9.1±4.9 years, range 0.4-20 years), 139 ischemic strokes occurred. The event rate per 100 patient-years was 1.28. After adjustment for various covariates, Cox regression analysis showed that stroke risk was not significantly associated with tertiles of MS in SBP in the population as a whole. When nondippers and dippers were analyzed separately by group-specific tertiles of MS in SBP, stroke risk was not associated with MS in nondippers. Conversely, in dippers, stroke risk was significantly higher in the third tertile (>23mm Hg) of MS in SBP (hazard ratio, 2.08; 95% confidence interval, 1.03-4.23; P = 0.04). Additional analysis showed that stroke risk was significantly and similarly higher in dippers with MS >23mm Hg and in nondippers than in dippers with MS <23mm Hg. In elderly patients treated for hypertension, high MS in SBP predicts stroke in dippers but not in nondippers. Nondippers are at high stroke risk with or without MS >23mm Hg.

Blood pressure variability parameters and the risk of developing hypertension in healthy young males: 5-year follow-up study

Purpose: Few prospective studies have evaluated increase Blood Pressure Variability (BPV) as a risk factor for onset hypertension in young populations. We conducted a prospective cohort study to examine the relationship of BPV to the onset of hypertension in healthy young males depending on family hypertensive anamnesis. Methods: Apparently healthy males aged 18-35 (n=366) without prevalent hypertension at baseline were enrolled in 2003-2005 years. All subjects took an annual medical checkup including Blood Pressure (BP) measurement, Ambulatory 24 hour Blood Pressure Monitoring (ABPM) and veloergometry - at baseline only; medical interview until 2010. The participants were categorized into 2 groups according to family anamnesis of hypertension (1st – positive family anamnesis, 2nd – negative one). Incident hypertension was defined as newly detected BP ≥140/90 mmHg and/or initiation of antihypertensive drugs. The incident hypertension was analyzed in each group. Results: During a median follow-up time of 4.6 years, there were 77 cases (21.0%) of incident hypertension. The incident hypertension rate of the 1st group was significantly higher than of the 2nd group (36.4% vs. 7.3%). The patients of the 1st group with incident hypertension in 5-year follow up had significant increased diastolic BP in veloergometry in comparison with men remained normotension. The range of morning systolic BP surge in ABPM was also higher (38.3±8.9 mmHg vs. 51.1±10.1 mmHg, p=0.039). In the 2nd group significant difference for these parameters was not revealed. The relative risks (RR) (95% confidence interval) adjusted for body mass index, excess salt intake, smoking status, and alcohol intake for incident hypertension in the 1st group in morning systolic BP surge by ABPM ≥50 mmHg was 1.43 (1.29–1.59); in the range diastolic BP in veloergometry >0% – 1.56 (1.29–1.59). Conclusions: Even if BP was within normal range, some parameters of blood pressure variability (systolic blood pressure morning surge in ABPM and elevated diastolic blood pressure in veloergometry) was a predictor of future hypertension in a healthy young-aged male population with positive family hypertensive anamnesis.

GW24-e3921 Association between the rate of the morning surge in blood pressure and cardiovascular events and stroke

ObjectivesThe exaggerated surge in morning blood pressure (BP) that many patients experience upon awakening may be closely related to target organ damage and may be a predictor of cardiovascular complications....

Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome

Ambulatory blood pressure (BP) monitoring provides information not only on the BP level but also on the diurnal changes in BP. In the present review, we summarized the main findings of the International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO) with regard to risk stratification based on BP variability. The predictive accuracy of daytime and nighttime BP and the night-to-day BP ratio depended on the disease outcome under study and treatment status, and differed for fatal outcomes compared with the composite of fatal and nonfatal diseases. An exaggerated morning surge, exceeding the 90th percentile of the population, is an independent risk factor for mortality and cardiovascular and cardiac events. Conversely, a sleep-trough or preawakening morning surge in systolic BP below 20 mm Hg is probably not associated with an increased risk of death or cardiovascular events. BP variability as captured by the average of the daytime and nighttime s.d. weighted for the duration of the daytime and nighttime interval (s.d.(dn)) and the average real variability (ARV(24)) predicted the outcome, but improved the prediction of the composite of all cardiovascular events by only 0.1%. In conclusion, the IDACO observations support the concept that BP variability adds to risk stratification, but above all highlight that 24-h ambulatory BP level remains the main predictor to be considered in clinical practice.

The effect of telmisartan and ramipril on early morning blood pressure surge: a pooled analysis of two randomized clinical trials

The period of early morning blood pressure surge is associated with a higher incidence of cardiovascular events than at other times of the day. Antihypertensive medication given once daily in the morning may not protect against this surge if its duration of action is too short. We compared telmisartan, an angiotensin II receptor blocker with a trough-to-peak ratio >90%, with ramipril, an angiotensin-converting enzyme inhibitor with a trough-to-peak ratio of around 50%. Data from two prospective, randomized, open-label, blinded endpoint studies comparing telmisartan force titrated to 80 mg once daily and ramipril 10 mg once daily were pooled. Patients had mild-to-moderate hypertension and were assessed using 24-h ambulatory blood pressure monitoring at baseline and endpoint. Early morning blood pressure surge was defined as the difference between mean blood pressure within 2 h after arising and night-time low. Patients were grouped into quartiles according to their baseline systolic surge. Data from 1279 patients were analyzed. Telmisartan changed the overall mean (SE) systolic surge by -1.5 (0.47) mmHg, and ramipril by +0.3 (0.47) mmHg (P=0.0049). The magnitude of surge reduction was greatest in the quartile with highest baseline systolic surge: telmisartan -12.7 (0.91), ramipril -7.8 (1.02) mmHg (P=0.0004). Telmisartan also reduced the surge compared with ramipril in dippers, but there were no differences between the two groups in nondippers. Telmisartan significantly reduced the early morning systolic blood pressure surge compared with ramipril. A reduction in this surge may help to reduce cardiovascular events in the morning period.

Nocturnal blood pressure dip and morning blood pressure surge: A 24-hour ambulatory blood pressure monitoring study

Abnormal nocturnal blood pressure (BP) dip as well as the morning BP surge have been found to be predictors of risk for cerebrovascular accidents (CVA). The purpose of this study was to investigate if there is a correlation between the nocturnal BP dip and the morning BP surge determined by ambulatory BP monitor. We studied 19 consecutive hypertensive patients referred to our hypertension clinic for the performance of ambulatory BP monitoring. There were 8 male and 11 female patients. Their ages ranged between 46 to 87 years of age (mean 65.2 ± 13 years). These patients were all taking BP medicines, but were not adequately controlled. There were 8 normal dippers and 11 abnormal dippers. The mean value of the dipping status was 7.2 ± 6.4 (SD) mmHg. The morning BP surge was calculated using the formula introduced by Kario et al in a recent communication. We determined the high morning systolic BP in the 2 hours following awakening. The low systolic BP was obtained from the average of the lower systolic BP during sleep and the immediate before and after systolic BP. The morning BP surge was obtained by the subtraction of the high morning systolic BP from the lower systolic BP. The mean value for the morning BP surge for this group of patients was 16.7 ± 13.1 (SD) mmHg. The calculated Pearson's coefficient of correlation was 0.644, the SE was 5 mmHg and this correlation was significant at the p=0.01 (2 tailed). We concluded from this study that abnormal nocturnal BP dip has a significant correlation with morning BP surge and is probably a co-contributor in the increased risk for cerebrovascular accidents. Further studies are needed in patients with significant risk factors for the production of CVAs to see if these variables, systolic nocturnal BP dip and morning systolic BP surge, are predictive for increased risk of cerebrovascular accidents.