Exaggerated Morning Surge in Blood Pressure in Hypertension

Cardiovascular events occur more frequently in the morning. Ambulatory blood pressure (BP) varies along with various physical and psychological factors, and this BP variability may be confer risk for cardiovascular events. In recent years, clinical research using ambulatory BP monitoring (ABPM)1 or self-measured home BP monitoring has clarified that both morning BP and BP surge are more closely related to target organ damage and cardiovascular risk than is clinic BP. In the present study, Head et al applied the interesting new filling model to calculate the rate of morning BP surge.2 Several investigative groups have recently attempted to investigate morning ambulatory BP variability. These investigators found that the rate of morning surge was exaggerated in hypertensive patients with higher daytime BP than those with lower daytime BP. In our previous study in elderly hypertensive patients, the two major determinants of morning BP surge are advancing age and higher BP levels. Thus the clinical implication of morning BP surge seems to be higher in hypertensive patients, particularly in older hypertensive patients with cardiovascular remodeling. Although this point is interesting, there are several points that remained to be addressed.