Early morning surge in blood pressure

Shimada, Kazuyuki; Kario, Kazuomi; Umeda, Yuji; Hoshide, Satoshi; Hoshide, Yoko; Eguchi, Kazuo

doi:10.1097/00126097-200112000-00015

Cited by 48 publications

(41 citation statements)

References 29 publications

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“…This means that minimal drug levels, and hence the pharmacodynamic trough effect, coincide with the early morning surge in blood pressure. 26 Blood pressure control throughout the 24-h period is important to gain complete benefit from antihypertensive therapy. The Study on Ambulatory Monitoring of blood Pressure and Lisinopril Evaluation (SAMPLE) showed that LVH regression was predicted much more closely by treatment-induced changes in ambulatory blood pressure, which provide a measure of antihypertensive activity throughout the dosing interval, than clinic blood pressure, which indicates the extent of blood pressure control at an isolated time point.…”

Section: Discussionmentioning

confidence: 99%

“…The Study on Ambulatory Monitoring of blood Pressure and Lisinopril Evaluation (SAMPLE) showed that LVH regression was predicted much more closely by treatment-induced changes in ambulatory blood pressure, which provide a measure of antihypertensive activity throughout the dosing interval, than clinic blood pressure, which indicates the extent of blood pressure control at an isolated time point. 27 The morning is also the time of the day when the risk of cardiovascular events is at its highest, 26 hence, the importance of the control of blood pressure at this time to prevent target-organ damage and reduce cardiovascular morbidity. The present study established the superiority of telmisartan in the control of blood pressure at the end of the dosing interval.…”

Section: Discussionmentioning

confidence: 99%

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Freehand three-dimensional echocardiographic evaluation of the effect of telmisartan compared with hydrochlorothiazide on left ventricular mass in hypertensive patients with mild-to-moderate hypertension: a multicentre study

et al. 2003

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Antihypertensive efficacy, effects on left ventricular mass index (LVMI) and tolerability of telmisartan, an angiotensin II receptor blocker, were compared with those of hydrochlorothiazide (HCTZ). Adult patients with mild-to-moderate hypertension and an optimal acoustic window by two-dimensional echocardiography were randomised at baseline to 12 months' double-blind, once-daily treatment with telmisartan 80 mg or HCTZ 25 mg. Two-dimensional echocardiography and freehand precordial three-dimensional echocardiography and 24-h ambulatory blood pressure monitoring were performed at baseline and after treatment. Of the 41 telmisartan group patients and 28 HCTZ group patients, 40 and 25, respectively, completed the study. Following treatment, 24-h mean SBP (telmisartan 157 7 11 vs 133 7 7 mmHg, Po0.001; HCTZ 154 7 10 vs 144 7 11 mmHg, Po0.003) and DBP (telmisartan 96 7 6 vs 83 7 5 mmHg, Po0.001; HCTZ 95 7 7 vs 87 7 8 mmHg, Po0.003) were significantly reduced. Telmisartan produced significantly greater 24-h mean SBP and DBP reductions than HCTZ (Po0.001). LVMI was significantly reduced by telmisartan (141 7 16 vs 125 7 19 g/m 2 , Po0.001), but not by HCTZ (139 7 20 vs 135 7 22 g/m 2 ). Incidences of adverse events in both the treatment groups were low; two cases of hypokalaemia occurred with HCTZ. In conclusion, telmisartan 80 mg was well tolerated and significantly reduced SBP, DBP and LVMI after 12 months' treatment compared with HCTZ.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Freehand three-dimensional echocardiographic evaluation of the effect of telmisartan compared with hydrochlorothiazide on left ventricular mass in hypertensive patients with mild-to-moderate hypertension: a multicentre study

et al. 2003

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“…There is a marked diurnal variation in the onset of cardiovascular events, with a peak incidence of myocardial infarction, sudden cardiac death, and ischemic and hemorrhagic stroke occurring in the morning (6 AM to noon) (4)(5)(6)(7)(8)(9)(10)(11). In particular, 3-h after waking is the highest risk period of the day or night (6).…”

Section: Morning Hypertension: the Strongest Independent Risk Factor mentioning

confidence: 99%

“…This suggests that some pathogenic mechanism related to morning BP is more closely associated with stroke risk than the total vascular BP overload throughout the 24-h period. In the morning, a number of conditions, such as platelet hyperactivity, impaired fibrinolytic activity, and increased vasoconstriction, which are potential risk factors for triggering cardiovascular events, are aggregated (4,(8)(9)(10)(11)(18)(19)(20)(21)(22)(23)(24), and when coupled with the increased shear stress on the atherosclerotic vascular wall resulting from the morning BP surge, might trigger stroke events. Both morning BP level and morning BP surge in the Cox regression model were significantly associated with stroke risks.…”

Section: Morning Bp Levels and Stroke Incidencementioning

confidence: 99%

Morning Hypertension: The Strongest Independent Risk Factor for Stroke in Elderly Hypertensive Patients

et al. 2006

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Stroke occurs most frequently in the morning hours, but the impact of the morning blood pressure (BP) level on stroke risk has not been fully investigated in hypertensives. We studied stroke prognosis in 519 older hypertensives in whom ambulatory BP monitoring was performed, and who were followed prospectively. During an average duration of 41 months (range: 1-68 months), 44 stroke events occurred. The morning systolic BP (SBP) was the strongest independent predictor for stroke events among clinic, 24-h, awake, sleep, evening, and pre-awake BPs, with a 10 mmHg increase in morning SBP corresponding to a relative risk (RR) of 1.44 (p <0.0001). The average of the morning and evening SBP (Av-ME-SBP; 10 mmHg increase: RR =1.41, p =0.0001), and the difference between the morning and evening SBP (Di-ME-SBP; 10 mmHg increase: RR =1.24, p =0.0025) were associated with stroke risks independently of each other. The RR of morning hypertension (Av-ME-SBP ≥ 135 mmHg and Di-ME-SBP≥20 mmHg) vs. sustained hypertension (Av-ME-SBP ≥135 mmHg and Di-ME-SBP <20 mmHg) for stoke events was 3.1 after controlling for other risk factors (p =0.01). In conclusion, morning hypertension is the strongest independent predictor for future clinical stroke events in elderly hypertensive patients, and morning and evening BPs should be monitored in the home as a first step in the treatment of hypertensive patients. (Hypertens Res 2006; 29: 581-587)

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“…CARDIOVASCULAR events occur most frequently in the morning 1,2) especially within 3 hours after waking.…”

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confidence: 99%

<b>Bedtime Administration of Cilnidipine Controls Morning Hypertension</b>

et al. 2007

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SUMMARYMorning blood pressure (BP) level plays an important role in the incidence of cardiovascular disease. Recently, Kario, et al proposed the usefulness of ME difference (morning minus evening systolic BP) and ME average (average of morning and evening systolic BP) for the evaluation of antihypertensive treatment. Cilnidipine is a novel calcium channel blocker (CCB) that exerts inhibitory actions not only on L-type but also on N-type calcium channels. We investigated the effect of bedtime administration of cilnidipine (10 mg) in addition to the antihypertensive treatment for uncontrolled morning hypertension. Twenty-three hypertensive outpatients (13 males and 10 females; mean age, 66.9 years) with stable antihypertensive medication and uncontrolled morning BP were studied using self-measured BP monitoring in the morning and evening. Morning SBP (P < 0.001) and DBP (P < 0.001) decreased significantly from 150.2 ± 8.7 and 87.8 ± 9.3 to 132.7 ± 7.4 and 77.5 ± 8.5 mmHg, respectively, after the addition of cilnidipine. Morning heart rate did not change (63.3 ± 7.0 to 64.1 ± 9.4). The evening SBP, but not DBP, decreased significantly after treatment. Both the ME average (P < 0.001) and ME difference (P < 0.01) significantly decreased from 143.0 ± 9.2 and 14.3 ± 12.4 to 131.3 ± 7.2 and 2.8 ± 9.2 mmHg after treatment, respectively. The microalbuminuria decreased from 39.6 ± 13.2 to 27.3 ± 8.4 mg/g Cr. In conclusion, L-/N-type CCB cilnidipine may be useful for patients with uncontrollable morning hypertension by reducing both ME average and ME difference. (Int Heart J 2007; 48: 597-603) Key words: L-/N-type calcium channel blocker, Morning hypertension, Microalbuminuria CARDIOVASCULAR events occur most frequently in the morning 1,2) especially within 3 hours after waking.3) An elevated morning blood pressure (BP) level has been associated with target organ damage: left ventricular hypertrophy 4) and microalbuminuria.5) Recent reports demonstrated that morning hypertension measured either by ambulatory BP monitoring (ABPM) 6) or by self-measured BP From the

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Early morning surge in blood pressure

Cited by 48 publications

References 29 publications

Freehand three-dimensional echocardiographic evaluation of the effect of telmisartan compared with hydrochlorothiazide on left ventricular mass in hypertensive patients with mild-to-moderate hypertension: a multicentre study

Freehand three-dimensional echocardiographic evaluation of the effect of telmisartan compared with hydrochlorothiazide on left ventricular mass in hypertensive patients with mild-to-moderate hypertension: a multicentre study

Morning Hypertension: The Strongest Independent Risk Factor for Stroke in Elderly Hypertensive Patients

<b>Bedtime Administration of Cilnidipine Controls Morning Hypertension</b>

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