Prognostic Utility of Morning Blood Pressure Surge for 20‐Year All‐Cause and Cardiovascular Mortalities: Results of a Community‐Based Study

Abstract

BackgroundMorning blood pressure (BP) surge (MS), defined by the MS amplitude, is an independent prognostic factor of cardiovascular outcomes in some, but not all, populations.Method and ResultsWe enrolled 2020 participants (1029 men; aged 30–79 years) with 24‐hour ambulatory BP data. During a median 19.7‐year follow‐up, 607 deaths (182 by cardiovascular causes) were confirmed from the National Death Registry. The amplitude of sleep‐trough MS (STMS) was derived from the difference between morning systolic BP (SBP) and lowest nighttime SBP. The rate of STMS was derived as the slope of linear regression of sequential SBP measures on time intervals within the STMS period. Thresholds for high STMS amplitude and rate were determined by the 95th percentiles (43.7 mm Hg and 11.3 mm Hg/h, respectively). Multivariable Cox models, adjusting for age, sex, body mass index, smoking, alcohol, low‐density lipoprotein cholesterol, 24‐hour SBP, night:day SBP ratio, and antihypertensive treatment, revealed that a high STMS rate (hazard ratio, 1.666; 95% confidence interval, 1.185–2.341), but not STMS amplitude (hazard ratio, 1.245; 95% confidence interval, 0.984–1.843), was significantly associated with a greater mortality risk. Similarly, STMS rate (hazard ratio, 2.608; 95% confidence interval, 1.554–4.375), but not STMS amplitude, was significantly associated with the risk of cardiovascular mortality (hazard ratio, 0.966; 95% confidence interval, 0.535–1.747). Moreover, the prognostic values of STMS rate were comparable in subjects with or without morning and nocturnal hypertension (P>0.05 for interaction for all). In simulation studies, STMS rate was less susceptible to measurement errors of the sleep‐trough SBP than STMS amplitude.Conclusions STMS rate could independently help identify subjects with an increased cardiovascular risk.

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

“…Similar to the JMS‐ABPM study, IDACO data showed that individuals with morning BP surge values in the top decile were at risk of mortality or cardiovascular events after controlling for covariates including age and 24‐hour BP. A recent long‐term prospective study of more than 2000 subjects with ABPM data followed for a median of 20 years showed that the sleep‐trough morning surge rate (defined as the slope of linear regression of sequential SBP values against time intervals within the morning surge period) was an independent predictor of cardiovascular death (hazard ratio 2.61) whereas the amplitude of the morning surge was not significantly associated with cardiovascular mortality risk …”

Prognostic value of sleep-through blood pressure surge in patients with essential hypertension

“…17 A recent large study of 2,020 participants reported that the frequency of increases in sleep-through surges rather than the amplitude of these surges was associated with worse cardiovascular outcomes. 18 Verdecchia et al, 19 explored the link between the early morning blood pressure surge and the major cardiovascular events in subjects with an initially untreated essential hypertension. They reported events in 16% of their subjects during a mean of 8-y follow-up.…”

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

“…Some recent studies proposed that the assessment of MBPS slope rather than its size might represent a more stable and clinically relevant alternative to MBPS amplitude assessment. 23 , 50 …”

“…The results were supported by a simulation analysis indicating that MBPS rate may be a more stable and robust indicator of BP changes in the morning. 50 …”