Patterns Of Blood Pressure Change Research Articles

PS-BPP02-3: FACTORS FOR NEW-ONSET ISOLATED DIASTOLIC HYPERTENSION AND PROGRESSION TO SYSTOLIC HYPERTENSION IN JAPAN

Objective: Factors for New-Onset of isolated diastolic hypertension (IDH: systolic blood pressure ≧ 140 mmHg and diastolic blood pressure ≧ 90 mmHg) have been identified as increasing body mass index (BMI), young age at baseline, male, and BMI by analysis of the Framingham Study in middle-class Caucasians. However, in Japanese, there are few reports of predictors of IDH or the progression from IDH to systolic and diastolic hypertension (SDH: systolic blood pressure ≧ 140 mmHg and diastolic blood pressure ≧ 90 mmHg). Method: The present study analyzed 42,591 subjects aged 35 to 65 years who underwent a health checkup between 2007 and 2013 and re-examined 5 years later. A logistic regression analysis was performed for three patterns of blood pressure change (normal to IDH, normal to SDH, and IDH to SDH) after 5 years from the time of the first health checkup. Systolic and diastolic blood pressure, age, gender, smoking habit, exercise habit, fasting blood glucose level, total cholesterol level, heart rate, and BMI were used as factors for adjustment. Results: At the time of the first checkup, 29,965 subjects were normotensive, 1,169 had IDH, and 11,457 had SDH. Of the 29,965 normotensive subjects, 566 developed IDH after 5 years. Multivariate logistic regression analysis adjusted for blood pressure showed a 1-unit increase in age (OR 0.96, CI[0.95–0.97], p < 0.0001), men (OR 1.44, CI[1.14–1.82], p = 0.002), BMI (OR 1.03, CI[1.00–1.06], p = 0.002), and a 1-unit increase in heart rate (OR 1.02, CI[1.01–1.03], p < 0.0001) were independently significant predictors of developing IDH. Of the 29,965 normotensive subjects, 4,631 developed SDH after 5 years, and all factors except heart rate were independently significant predictors. On the other hand, 612 (52%) of the 1,169 subjects with IDH at the initial visit developed SDH 5 years later. The first checkup systolic blood pressure was significantly (p < 0.0001, 132.3 ± 5.5 mmHg vs. 129.5 ± 6.5 mmHg) higher, but no factors were found to be associated with the development of SDH. Conclusions: In Japanese subjects, IDH predominantly occurs in young, male, obese, and high heart rate individuals. However, the progression from IDH to SDH is difficult to predict, and it is important to prevent obesity from developing IDH.

Investigating the Relationship between Alcohol Use and Patterns of Blood Pressure Change Due to Examination Stress among Adekunle Ajasin University Academic Staff

Aim: This study examined the relationship between alcohol use and patterns of blood pressure changes due to examination stress among academic staff at the Adekunle Ajasin University (AAUA).Methods: It involved using concurrent mixed methods with quantitative and qualitative approaches. Both the questionnaire and the blood pressure and pulse rate reading were used as instruments in data collection. The examined population includes all academic staff of AAUA. Multistage sampling techniques were used to select participants for the study. In stage one, a simple random sampling technique was used to select five faculties of the university. In stage two, systematic sampling techniques were used to select participants for the study; academic staff in every 5th academic staff office at the selected faculties were selected as a sample frame. Two instruments were used in gathering information for this study. The instruments were a self-constructed questionnaire and an electronic sphygmomanometer. Data were analyzed using mean and standard deviation at alpha level of 0.05.Results: Findings revealed that there is a significant difference in the pattern of blood pressure before – F (3, 46) = 4.260, P < 0.05; during – F (3, 46) = 3.570, P < 0.05; and after the examination period – F (3, 46) = 3.131, P < 0.05, based on the respondents’ level of alcohol intake.Conclusions: It is recommended that academic staff should be educated on the detrimental health consequences of consuming alcohol to avoid high blood pressure before, during and after the examination period.

Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study.

The present study aimed to investigate the associations between the trajectory of blood pressure (BP) change and the risk of subsequent dementia and to explore the differences in age, gender, and hypertension subgroups. We included 10,660 participants aged ≥ 60 years from 1998 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Latent growth mixture models were used to estimate BP trajectories. Cox-proportional hazard models were used to analyze the effects of BP trajectories on the risk of dementia. According to the results, stabilized systolic BP (SBP) was found to be associated with a higher risk of dementia compared with normal SBP [adjusted hazard ratio (aHR): 1.62; 95% confidence interval (CI): 1.27-2.07] and elevated SBP (aHR: 2.22; 95% CI: 1.51-3.28) in and only in the subgroups of the oldest-old, women, and subjects without hypertension at baseline. Similarly, stabilized pulse pressure (PP) was associated with a higher risk of dementia compared with normal PP (aHR: 1.52; 95% CI: 1.24-1.88) and elevated PP (aHR: 2.12; 95% CI: 1.48-3.04) in and only in the subgroups of the oldest-old, women, and subjects with hypertension at baseline. These findings suggest that stabilized SBP and PP have predictive significance for the occurrence of dementia in late life, and the factors of age, gender, and late-life hypertension should be considered when estimating the risk of BP decline on dementia.

Determinants of Blood Pressure in Neonates and Infants: Predictable Variability.

The blood pressure (BP) of neonates, especially those born premature, changes rapidly over the first days and weeks of life. Neonatal BPs may be affected by maternal factors, perinatal factors or events, and intrinsic or extrinsic infant factors. Unfortunately, the effect of many maternal health and disease states has only been studied in small numbers or has shown conflicting results. Many events around the time of delivery have the potential to influence the neonatal BP, and while definitive studies are often lacking, some observational data support physiological expectations. The strongest determinants of neonatal BP are the infant factors of gestational age at birth, birth weight, and postmenstrual age. Understanding the expected pattern of BP changes, identifying the potential influencing factors, and accurately measuring the BP are all essential to determine whether there is a BP abnormality present but are also more complex in the neonatal population. This review describes the evidence for maternal conditions, perinatal events, and infant factors to affect neonatal BP. It also explains what is currently known about the changing BP patterns in neonates including those born preterm. In addition, by examining the physiological process of hemodynamic adaptation to the extrauterine environment and compensatory cardiovascular responses, we can gain insight into the expected and unexpected vascular responses, making the variability of neonatal BP seem a little more predictable.

Patterns of blood pressure changes in patients with head and neck cancer receiving radiotherapy or chemo-radiotherapy at a tertiary cancer centre.

To evaluate patterns of blood pressure (BP) changes in patients with head and neck cancer (HNC) receiving radiation (RT)/chemo-radiation (CRT) METHODS: This study included data collection, compilation, and analysis of 451 consecutive HNC patients who underwent RT/CRT. Out of 451 patients, 376 (82%) were male and 75 (18%) were female with a median age of 52 years. Patients receiving 3DCRT experienced greater fall in BP, including for SBP and MAP, compared to those receiving IMRT-IGRT. Female patients experienced greater fall in diastolic BP as compared to male patients (p: 0.03). At the end of treatment, we observed a significant association between a fall in systolic BP (decrease by 10% of baseline) and weight loss of more than 10% of baseline weight (p: 0.03). Fall in BP during RT/CRT is significantly affected by treatment technique and sex and is strongly associated with significant weight loss.

Non-Invasive Versus Invasive Blood Pressure Monitoring in Patients During Laparoscopic Bariatric Surgery: a Prospective Method-Comparison Study

Introduction: Intra-operative blood pressure monitoring in morbidly obese patients using standard non-invasive blood pressure (NIBP) oscillometric technique with upper arm cuffing is often inaccurate. Invasive arterial blood pressure (IABP) monitoring is the gold standard but is not without complications. The purpose of this study was done to assess the degree of agreement between the forearm and upper arm NIBP with the IABP during laparoscopic bariatric surgery. Patients and Methodsm The study was conducted in our university hospital. A total of 36 morbidly obese patients undergoing laparoscopic bariatric surgery were studied. The radial artery was cannulated for IABP monitoring on one upper limb while NIBP monitoring was done on the contralateral upper arm and forearm. The NIBP and its corresponding IABP readings were recorded at selected time points at 10 minutes post-induction; 5, 15, and 30 minutes post-insufflation and 15 minutes post- exsufflation. Results: The mean arterial pressure (MAP) has narrower limits of agreement compared to the systolic blood pressure (SBP) and diastolic blood pressure (DBP) for each method of measurement used. Forearm NIBP showed better agreement with IABP compared to upper arm NIBP. Repeated measures ANOVA showed a similar pattern of changes in SBP, DBP, and MAP measured by NIBP and IABP during the surgery. Conclusion: Similar patterns of blood pressure changes were observed with IABP, upper arm, and forearm NIBP measurements at all time points. The forearm NIBP showed better agreement to IABP as compared to upper arm NIBP and may be adequate to monitor patterns of blood pressure changes during laparoscopic bariatric surgery. Keywords: Weight loss surgery, intraoperative BP monitoring, Obesity, Hypertension, Forearm and upper arm BP monitoring, IABP, NIBP

Blood pressure assessments of pregnant women in a Day Assessment Unit - A prospective observational study.

We investigated the optimum time and number of observations for assessing women in the Day Assessment Unit. A single centre prospective observational study was undertaken. Women referred for blood pressure assessment in the Day Assessment Unit were recruited. The blood pressure of women who subsequently developed preeclampsia was noted to change differently over the time of observation compared to women with other hypertensive disorders, most notably in the first and third hour (p = 0.042), although the averages at each hour did not differ between these two groups. Mean blood pressure measured over four hours did not significantly differ compared to blood pressure measured over one hour. Women who subsequently developed preeclampsia had a different pattern of blood pressure change whilst in the Day Assessment Unit.

Patterns of Orthostatic Blood Pressure Changes in Patients with Orthostatic Hypotension.

Background and PurposeThe objective of this study was to determine the patterns of blood pressure (BP) changes during the head-up tilt (HUT) test, particularly in terms of its clinical significance for patients with orthostatic hypotension (OH).MethodsOH was divided into four categories based on systolic BP changes occurring within the first 10 minutes of the HUT test: sustained orthostatic hypotension (SOH), progressive orthostatic hypotension (POH), orthostatic hypotension with partial recovery (OHPR), and transient orthostatic hypotension (TOH).ResultsIn total, 151 patients were analyzed: 65 with SOH, 38 with POH, 21 with OHPR, and 27 with TOH. POH patients exhibited the greatest reduction in systolic BP after HUT and were also the most likely to develop symptoms requiring early termination of the HUT test (42.1%, p<0.001). Additionally, SOH patients exhibited smaller heart-rate variation with deep breathing values (p=0.003) and Valsalva ratios (p=0.022) compared to POH patients. The sweat volume was greatest in OHPR patients.ConclusionsClinical characteristics, including the findings of autonomic function tests, differed between the OH patient groups. This might reflect differences in the underlying pathophysiologic mechanisms. Determining the patterns of BP changes during the HUT test may facilitate the development of effective management strategies in patients with OH.

Detailed Relationship Between the Pattern of Blood Pressure Change During the Valsalva Maneuver and the Degree of Orthostatic Hypotension During the Head-Up Tilt Test in Patients With Orthostatic Intolerance: A Retrospective Case-Control Study.

Although the head-up tilt (HUT) test and Valsalva maneuver (VM) have been widely used to identify sympathetic adrenergic impairment, the detailed relationship between the degree of orthostatic hypotension (OH) during the HUT test and the pattern of blood pressure (BP) change during the VM remains unknown. This study was performed to investigate the relationship between the degree of OH during the HUT test and the pattern of BP change during the VM. During a 4-year period, a total of 132 consecutive patients with neurogenic OH and 60 healthy controls were enrolled. The degree of OH was defined as mild (associated with a fall in systolic BP [SBP] ≥ 20 < 30 on tilting, n = 49), moderate (associated with a fall in SBP ≥ 30 < 40 on tilting, n = 43), and severe (associated with a fall in SBP ≥ 40 on tilting, n = 40). A standardized battery of autonomic tests, including the HUT test and VM using Finometer devices for recording beat-to-beat BP and heart rate response, and a quantitative sudomotor axon reflex test, was performed. Sympathetic indexes (SIs 1–6) were calculated from the VM. A composite autonomic severity score (CASS) was also obtained to evaluate the severity and distribution of autonomic dysfunction. The degree of OH was compared with the BP decline and recovery during the VM. All indexes exhibited overall significant differences among tested groups (P < 0.001). Only SI 3 differentiated all subject groups. Compared with other SIs, SI 3 was best correlated with the amount of decrease in the mean SBP (R2 = 0.473, P < 0.001) on tilting. The decrease in mean SBP on tilting was best correlated with CASS adrenergic subscore. SI 3 can differentiate between groups with different degrees of OH. The SI 3 obtained during VM can improve the diagnostic accuracy of autonomic dysfunction in patients with different degree of OH.

Abstract P210: Systolic Blood Pressure Trajectories From Childhood to Adulthood and Depression in Middle Age: The Bogalusa Heart Study

Introduction: Few studies have examined the long term patterns of blood pressure change in relation to depression in middle age. Methods: We examined data from the Bogalusa Heart Study, a long-term community-based observational study of a biracial cohort, with first measurements in childhood in 1973. Men and women (n=909) who completed the Center for Epidemiologic Studies Depression Scale (CES-D) in 2010 with at least two childhood and two adult SBP measurements were included. CES-D scores were categorized using established cut points (&lt;8, 8-15, &gt;15). Discrete mixture modeling was employed to identify trajectory groupings of (SBP), adjusted for race (time-independent) and body mass index (time-varying). The association between SBP trajectory and CES-D scores were determined using multivariable logistic regression adjusted for antihypertensive use, education, and physical activity in 2010. Results: Mean (±SD) age was 43.1±4.5 years, 57.9% were female, and 31.7% were Black. 27.7% of participants were current smokers in 2010. Mean (SD) BMI was 31.0 (7.7). We identified four SBP patterns: always low but slightly increasing (46.8%), low and modestly increasing (22.6%), healthy and stable (21.8%), and profoundly increasing (8.9%). Relative to the largest group, the multivariable adjusted odds ratio (OR) of higher CES-D categorization, i.e. more depressed, for the modestly increasing was 1.47 (95% CI, 1.01-2.15), for the stable, 0.96 (95% CI, 0.66-1.39), and for the profoundly increasing, 1.93 (95% CI, 0.66-1.39). Each additional year of education was associated with 33% decreased odds of higher CES-D categorization (OR=0.67, 95% CI 0.59-0.77). Conclusions: Trajectories of SBP from childhood through adulthood are associated with depression in middle age. Individuals with increasing SBP may benefit from depression screening in early adulthood.

Relating Patterns of Blood Pressure Change During Pregnancy to Offspring Birth Size and Gestational Age at Delivery in a UK Birth Cohort.

Relating Patterns of Blood Pressure Change During Pregnancy to Offspring Birth Size and Gestational Age at Delivery in a UK Birth Cohort.

Hypertension Editors’ Picks

<i>Hypertension</i> Editors’ Picks

Associations of blood pressure change in pregnancy with fetal growth and gestational age at delivery: findings from a prospective cohort.

Hypertensive disorders of pregnancy are associated with intrauterine growth restriction and preterm birth. However, the associations of patterns of blood pressure change during pregnancy with these outcomes have not been studied in detail. We studied repeat antenatal blood pressure measurements of 9697 women in the Avon Longitudinal Study of Parents and Children (median [interquartile range], 10 [9-11] measurements per woman). Bivariate linear spline models were used to relate blood pressure changes to perinatal outcomes. Higher systolic, but not diastolic, blood pressure at baseline (8 weeks of gestation) and a greater increase in systolic and diastolic blood pressure between 18 and 36 weeks of gestation were associated with lower offspring birth weight and being smaller for gestational age in confounder-adjusted models. For example, the mean difference (95% confidence interval) in birth weight per 1 mm Hg/wk greater increase in systolic blood pressure between 18 and 30 weeks was -71 g (-134 to -14) and between 30 and 36 weeks was -175 g (-208 to -145). A smaller decrease in systolic and diastolic blood pressure before 18 weeks and a greater increase between 18 and 36 weeks were associated with a shorter gestation (percentage difference in gestational duration per 1 mm Hg/wk greater increase in systolic blood pressure between 18 and 30 weeks was -0.60% [-1.01 to -0.18] and between 30 and 36 weeks was -1.01% [-1.36 to -0.74]). Associations remained strong when restricting to normotensive women. We conclude that greater increases in blood pressure, from the 18-week nadir, are related to reduced fetal growth and shorter gestation even in women whose blood pressure does not cross the threshold for hypertensive disorders of pregnancy.

Non-dipping nocturnal blood pressure in psoriasis vulgaris

Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis carry an excess risk of hypertension and adverse cardiovascular (CV) events. Blood pressure (BP) has a circadian rhythm characterised with lower values at night. A blunted nocturnal BP decline defined as non-dipping accelerates the development of hypertension and CV diseases. The aim of this study is to evaluate circadian variation of blood pressure in normotensive middle-aged patients with psoriasis vulgaris. Seventy adult patients with psoriasis vulgaris (group 1) and 70 age and sex-matched healthy individuals (group 2) were included in the study. Ambulatory BP monitoring was performed in all participants over a 24-h period. Non-dippers are defined as those who show a reduction in BP of less than 10% between the average day and night systolic BP. Although mean 24-h BPs were similar in both groups, night-time BPs were significantly higher in psoriatic patients (115.1 ± 7.7 vs. 109.9 ± 6.0mmHg and 72.1 ± 7.0 vs. 67.6 ± 5.5mmHg, respectively; p < 0.05). The non-dipping pattern of BP changes was significantly more common in patients with psoriasis vulgaris compared with the control group (65.9 vs. 34.1%, p < 0.01). Psoriasis severity and BMI are independent predictors of impaired nocturnal BP regulation. Patients with psoriasis vulgaris had increased nocturnal BP and heart rate. This is the first study to demonstrate a blunted nocturnal BP decrease in normotensive patients with psoriasis.

Triphasic blood pressure responses to cannabinoids: do we understand the mechanism?

The cannabinoids comprise three major classes of substances, including compounds derived from the cannabis plant (e.g. Δ(9) -tetrahydrocannabinol and the chemically related substances CP55940 and HU210), endogenously formed (e.g. anandamide) and synthetic compounds (e.g. WIN55212-2). Beyond their psychotropic effects, cannabinoids have complex effects on blood pressure, including biphasic changes of Δ(9) -tetrahydrocannabinol and WIN55212-2 and an even triphasic effect of anandamide. The differing pattern of blood pressure changes displayed by the three types of compounds is not really surprising since, although they share an agonistic effect at cannabinoid CB(1) and CB(2) receptors, some compounds have additional effects. In particular, anandamide is known for its pleiotropic effects, and there is overwhelming evidence that anandamide influences blood pressure via (i) CB(1) receptors, (ii) TRPV1 receptors, (iii) endothelial cannabinoid receptors and (iv) degradation products. This review is dedicated to the description of the effects of externally added cannabinoids on cardiovascular parameters in vivo. First, the cardiovascular effects of cannabinoids in anaesthetized animals will be highlighted since most data have been generated in experiments of that type. The text will follow the three phases of anandamide on blood pressure, and we will check to which extent cardiovascular changes elicited by other cannabinoids show overlap with those effects or differ. The second part will be dedicated to the cardiovascular effects of the cannabinoids in conscious animals. In the third part, cardiovascular effects in humans will be discussed, and similarities and differences with respect to the data from animals will be examined.

Established preeclampsia risk factors are related to patterns of blood pressure change in normal term pregnancy

Hypertension during pregnancy is one of the diagnostic criteria for preeclampsia. We investigated the pattern of blood pressure (BP) change across pregnancy and associations of risk factors for preeclampsia with BP changes in normal pregnancy. We examined repeat antenatal BP measurements (median 14 per woman) of 11,789 women from the Avon Longitudinal Study of Parents and Children cohort with a live-term birth and no evidence of preeclampsia or previous hypertension. Linear spline random effects models with knots at 18, 30 and 36 weeks gestation described changes in BP with gestational age. On average, SBP and DBP decreased slowly until 18 weeks and rose from 18 weeks onwards, with increasing rate at 30 weeks and then again at 36 weeks. In obese women, BP was higher at 8 weeks and rose more slowly between 18 and 30 weeks and more rapidly between 30 and 36 weeks than in normal-weight women. Nulliparous women had higher BP at 8 weeks and faster increases in DBP from 30 weeks and SBP from 36 weeks onwards than multiparas. Women who smoked throughout pregnancy had lower BP at 8 weeks and throughout pregnancy; women who only smoked in the first trimester soon attained the same pattern of change as never smokers. In twin pregnancies, BP rose more rapidly from 30 weeks onwards than in singleton pregnancies. Established preeclampsia risk factors are associated with higher BP in early pregnancy and faster BP increases later in gestation in normal pregnancy, suggesting a continuum of risk.

P2-166 Relationships of risk factors for pre-eclampsia with blood pressure changes during normal term pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC)

ObjectiveIt is unclear whether established risk factors for pre-eclampsia are related to blood pressure (BP) changes across pregnancy in women who do not develop pre-eclampsia. We investigated these associations.MethodsWe studied...

How to Best Assess Blood Pressure?

See related article, pp 1087–1093 It is half a century since high blood pressure (BP) measured in the doctor's office has been proved to be a strong predictor of cardiovascular morbidity and mortality. However, it soon became clear that multiple factors can significantly affect the BP measurement result (Table 1) and may thereby have considerable impact on its prognostic ability. View this table: Table 1. Aspects of the BP Measurement That Might Influence Its Assessment Despite the intensive research with almost 120 000 PubMed papers on issues related to BP monitoring, the question “how to best assess BP” is still a matter of hot debate. Notwithstanding these difficulties, research in the field of BP monitoring has considerably refined the BP measurement procedure, by systematically addressing all factors listed in Table 1. Such improvement has included a better standardization of methods as well as the development of multiple approaches to BP quantification, aiming to more precise risk prediction. This was achieved not only by a more accurate estimation of mean BP, but also by the evaluation of different patterns of BP variation over time. Although, irrespective of the measurement methodology (Table 1), any BP value is by itself a powerful index of risk, several aspects of BP dynamics assessed by considering patterns of BP change over time have been proved to increase the prognostic ability of BP, over and above the information provided by conventional office measurements. Practicing physicians, as well as patients themselves (particularly …

Folic acid is positively associated with uteroplacental vascular resistance: The Generation R Study

Background and aims Periconception folic acid supplementation may influence early placentation processes and thereby the occurrence of hypertensive pregnancy disorders. For this reason we examined the associations between periconception folic acid supplementation and uteroplacental vascular resistance, blood pressure, and the risks of gestational hypertension and preeclampsia, in 5993 pregnant women, participating in a population-based cohort study. Methods and results Folic acid supplementation was assessed by questionnaire. Mean pulsatility index (PI) and resistance index (RI) of the uterine (UtA) and umbilical arteries (UmA) were measured by Doppler ultrasound in mid- and late pregnancy. Systolic and diastolic blood pressures (SBP, DBP) were measured in early, mid- and late pregnancy. Compared to women who did not use folic acid, preconception folic acid users had a slightly lower UtA-RI in mid-pregnancy [β −0.02, 95% confidence interval (CI) −0.03, −0.01] and late pregnancy [β −0.02, 95% CI −0.03, −0.001], a lower UtA-PI in mid-pregnancy [β −0.06, 95% CI −0.1, −0.03] and late pregnancy [β −0.03, 95% CI −0.05, −0.01], as well as tendencies towards a lower UmA-PI in mid-pregnancy [β −0.02, 95% CI −0.04, −0.001] and late pregnancy [β −0.01, 95% CI −0.02, 0.01]. Additionally, these women had slightly higher SBP and DBP throughout pregnancy. Neither the patterns of blood-pressure change during pregnancy, nor the risk of gestational hypertension and preeclampsia differed between the folic acid categories. Conclusion Periconception folic acid supplementation is associated with lower uteroplacental vascular resistance and higher blood pressures during pregnancy. The effects are small and within physiologic ranges and seem not associated with the risk of hypertensive pregnancy disorders.

UNDERSTANDING THE MORNING RISE IN BLOOD PRESSURE

1. The morning period has been recognized as the highest risk period of the day for cardiovascular events, particularly stroke and is also associated with a rapid surge in blood pressure. 2. Evidence now exists to show that the morning surge in blood pressure is an independent risk factor in some elderly hypertensive subjects. 3. However, methods to assess the contribution of the morning blood pressure surge from ambulatory recordings or home recordings, using clock times or times of waking, do not take into consideration the individual patterns of blood pressure change which can range from a rapid rise prior to or following waking to a slow increase over several hours. 4. In the present review we describe a novel method for determining the individual changes using a double logistic equation fitted to the individual pattern of blood pressure change. 5. Methods are presented to determine the rate of rise function over the morning period as well as predicting the change over a fixed time window which may be useful in refining the contribution of the blood pressure surge to cardiovascular risk. 6. Hypertensive people have an exaggerated rise in morning blood pressure as well as a greater rate of rise. 7. Antihypertensive drugs and dosing regimes are being developed which may be useful adjuncts to standard therapy for preventing morning hypertension and hopefully also reducing cardiovascular damage or events.