Age is an Independent Risk Factor for the Early Morning Blood Pressure Surge in Patients Never-Treated for Hypertension

Abstract

Background and ObjectivesThe early morning blood pressure surge (EMBPS) has been reported to be associated with cardiovascular events. The aim of this study was to investigate the relationship between 24-hour ambulatory BP monitoring (ABPM) parameters and conventional cardiovascular risk factors.Subjects and MethodsPatients (n=346) never-treated for essential hypertension with no other cardiovascular risk factors, such as diabetes, dyslipidemia, and nephropathy were enrolled. The EMBPS was defined as the early morning systolic BP minus the lowest night systolic BP. We compared the 24-hour ABPM parameters in two groups divided by age (<60 and ≥60 years) and examined the association between the 24-hour ABPM parameters and cardiovascular risk factor.ResultsThe EMBPS (18±14 vs. 24±14 mmHg, p=0.002), 24-hour mean blood pressure {MBP; 102±9 vs. 105±11 mmHg, p=0.044}, and 24-hour mean pulse pressure (PP; 52±10 vs. 58±11 mmHg, p<0.001) were significantly increased in the elderly subjects compared to the younger subjects. The degree of decrease was less in the elderly subjects (10±8 vs. 7±10%, p=0.002). Based on multivariate analysis, age was an independent risk factor for the highest quartile of EMBPS (>28 mmHg) after adjusting for gender differences, body mass index, and various 24-hour ABPM parameters (odds ratio, 1.051; 95% confidence interval, 1.028-1.075; p<0.001).ConclusionAge is an independent risk factor for EMBPS in patients with never-treated hypertension. BP control in the early morning period is more important in elderly patients so as to prevent cardiovascular events.

Blood Pressure Variability and Morning Blood Pressure Surge in Elderly Chinese Hypertensive Patients

“…18 In the current study, the finding of age as an independent risk factor associated with MBPS was confirmed in Chinese hypertensive patients:…”

Ethnic Differences in the Degree of Morning Blood Pressure Surge and in Its Determinants Between Japanese and European Hypertensive Subjects

“…In a study in untreated Korean hypertensive patients, the reported sleep-trough MS values were considerably lower than those in our study and comparable with those obtained in Europeans. 28 Further data supporting the presence of higher MS in the Japanese population come from the Ohasama study. In this study, sleep-trough BP MS was higher than that in the European hypertensive patients in our study (33 mm Hg), even though Ohasama study included subjects from a general population with lower age (mean 61 years) and lower 24-hour BP levels (mean 123/72 mm Hg).…”

“…This demonstration is important on the background of previous findings by Kario et al, which clearly showed that BP MS is related to 24-hour BP levels and to age, at least in Japanese subjects. 24,28 In fact, when we compared the sleep-trough MS between our 2 ethnic groups, by considering only subjects carefully matched for age and 24-hour BP levels, the difference in sleep-trough MS of BP between these 2 groups remained significant.…”

Morning blood pressure surge is associated with serum gamma-glutamyltransferase activity in essential hypertensive patients

“…21 Neutel et al 16 found that increasing age was associated with a higher SBP MBPS. However, in the multivariate analysis, age was not significantly associated with MBPS and the authors suggested that the age effect is fully accounted for by changes in other variables, such as BP variability in elderly patients.…”

“…Lee et al 21 reported that in never-treated essential hypertensive patients, with no other cardiovascular risk factors, age was an independent risk factor for MBPS. 21 Neutel et al 16 found that increasing age was associated with a higher SBP MBPS.…”