Morning blood pressure surge: pathophysiology, clinical relevance and therapeutic aspects

Grzegorz Bilo, Andrea Grillo, Valentina Guida, Gianfranco Parati, Grzegorz Bilo, Andrea Grillo, Valentina Guida, Gianfranco Parati

Abstract

Morning hours are the period of the day characterized by the highest incidence of major cardiovascular events including myocardial infarction, sudden death or stroke. They are also characterized by important neurohormonal changes, in particular, the activation of sympathetic nervous system which usually leads to a rapid increase in blood pressure (BP), known as morning blood pressure surge (MBPS). It was hypothesized that excessive MBPS may be causally involved in the pathogenesis of cardiovascular events occurring in the morning by inducing hemodynamic stress. A number of studies support an independent relationship of MBPS with organ damage, cerebrovascular complications and mortality, although some heterogeneity exists in the available evidence. This may be due to ethnic differences, methodological issues and the confounding relationship of MBPS with other features of 24-hour BP profile, such as nocturnal dipping or BP variability. Several studies are also available dealing with treatment effects on MBPS and indicating the importance of long-acting antihypertensive drugs in this regard. This paper provides an overview of pathophysiologic, methodological, prognostic and therapeutic aspects related to MBPS.

Keywords: ambulatory blood pressure monitoring; blood pressure variability; cardiovascular risk; morning blood pressure surge.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Sleep-trough morning SBP surge in two groups of Japanese (gray) and European (black) subjects, respectively. Notes: Data adjusted for sex, body mass index, smoking, diabetes mellitus and 24-hour mean SBP. Data are separately shown for four different age groups. Values are expressed as means±SEM. *P<0.001 Japanese vs. European group in the same category. Hoshide S, Kario K, de la Sierra A, et al, Ethnic differences in the degree of morning blood pressure surge and in its determinants between Japanese and European hypertensive subjects novelty and significance, Hypertension, 2015, 66, 750–756, http://hyper.ahajournals.org/. Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Wolters Kluwer. Please contact permissions@lww.com for further information. Abbreviations: SBP, systolic blood pressure; SEM, standard error of the mean.
Figure 2
Figure 2
Pathophysiology of morning BP surge. Abbreviations: BP, blood pressure; CV, cardiovascular; RAAS, renin–angiotensin–aldosterone system.

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