Key result
When measured as a continuous variable, a 10 mm Hg increase in morning blood pressure surge was associated with an increased risk of stroke (HR 1.11; 95% CI 1.03-1.20).
Why the study?
Is an exaggerated morning blood pressure surge associated with an increased risk of cardiovascular events and stroke?
Systematic Review (n=17)
Is an exaggerated morning blood pressure surge associated with an increased risk of cardiovascular events and stroke?
Hazard Ratio: 1.11 (95% CI 1.03–1.2)
When measured as a continuous variable, increasing levels of morning blood pressure surge are associated with an increased risk of stroke.
May aid stroke risk stratification; extends observational meta-analyses but leaves causal effects and intervention benefits open.
BACKGROUND: An exaggerated morning blood pressure surge (MBPS) may be associated with stroke and other cardiovascular events, but the threshold at which an MBPS becomes pathological is unclear. This study aimed to systematically review the existing literature and establish the most appropriate definition of pathological MBPS. METHODS: A MEDLINE search strategy was adapted for a range of literature databases to identify all prospective studies relating an exaggerated MBPS to cardiovascular endpoints. Hazard ratios (HRs) were extracted and synthesized using random-effects meta-analysis. RESULTS: The search strategy identified 2,964 unique articles, of which 17 were eligible for the study. Seven different definitions of MBPS were identified; the most common was a prewaking surge (mean blood pressure for 2 hours after wake-up minus mean blood pressure for 2 hours before wake-up; n = 6 studies). Summary meta-analysis gave no clear evidence that prewaking MBPS (defined by a predetermined threshold: >25-55 mm Hg) was associated with all cardiovascular events (n = 2 studies; HR = 0.94, 95% confidence interval (CI) = 0.39-2.28) or stroke (n = 2 studies; HR = 1.26, 95% CI = 0.92-1.71). However, using a continuous scale, which has more power to detect an association, there was evidence that a 10 mm Hg increase in MBPS was related to an increased risk of stroke (n = 3 studies; HR = 1.11, 95% CI = 1.03-1.20). CONCLUSIONS: These findings suggest that when measured and analyzed as a continuous variable, increasing levels of MBPS may be associated with increased risk of stroke. Large, protocol-driven individual patient data analyses are needed to accurately define this relationship further.
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Sheppard et al. (2014) conducted a systematic review in Cardiovascular events and stroke (n=17). Morning blood pressure surge (MBPS) vs. Lower MBPS was evaluated on Stroke (per 10 mm Hg increase in MBPS) (HR 1.11, 95% CI 1.03-1.20). When measured as a continuous variable, a 10 mm Hg increase in morning blood pressure surge was associated with an increased risk of stroke (HR 1.11; 95% CI 1.03-1.20).
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