Abstract:Objective: Morning hypertension is currently the blind spot in the clinical practice of hypertension, home 24-hour blood pressure measurement has been recommended in patients with a high clinic blood pressure and patients with target organ damage. Aim: To assess whether an increased early morning blood pressure surge, established via a single 24-hour blood pressure monitoring, in treated elderly hypertensive's is related to more prominent target organ damage. Material and methods: 310 treated hypertensive patients randomly attended the out-patient clinic of our hypertension centre. The patients were divided in 2 groups: systolic/diastolic blood pressure hypertension (n = 266) and isolated systolic hypertension (n = 44 76 ±10 yrs). Results: Equivalent in both males and females, despite the rise in nondippers with an early morning surge (higher in females). Hyperlipidemia arises equally in dippers and nondippers, 45 % of nondippers had diabetes mellitus; 30 % suffered previous renal insuffi ciency and about 29 % of patients suffered from an endocrine disorder, mostly thyroid. Metabolic syndrome was only found to be associated with a nondipping pattern (3 %). Left ventricular hypertrophy was present in 100 % of patients, heart failure in 60 % nondippers and 56 % dippers, potential renal insuffi ciency in 34 % nondippers and 22 % dippers, retinopathy in 31 % non dippers and 11 % dippers, aortic aneurysm was only in nondippers. Conclusion: Early morning surge is a predictor of hypertensive target organ damage, being a dipper or nondipper patient with isolated systolic hypertension, might not make a difference depending on one's own degree of target organ damage and diurnal variation (Fig. 2 Despite a diffi culty to diagnose and treat hypertension, this condition remains worldwide the leading cause of cardiovascular morbidity and mortality and goal blood pressure levels are seldom achieved. It is therefore highly desirable to improve this unsatisfactory delivery of care in the fi eld of hypertension, an increasing number of clinical trials allow the formulation of guidelines to support a more effective strategy. Multifaceted interventions are required to implement guidelines successfully, going from the dissemination of recommendations to educational programs at the practice site. This paper is a current contribution to the above directionThe following are the main aims: 1) To prove the link between isolated systolic increase in blood pressure (non-dippers) and the incidence of hypertension in elderly subjects.2) To compare the use of non-invasive blood pressure investigational methods versus management.3) Prognosis of cardiovascular and cerebrovascular disease resulting from ISH in non-dippers? Material and methodsThe extent to which the morning BP surge is a direct cause of cardiovascular disease is still to be proven, but a clear association has been demonstrated. An excessive morning blood pressure surge appears to be a risk factor for cardiovascular disease, particularly in older hypertensive patients wi...
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