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

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.

Ethnic disparities in the morning surge: Which utility for typifying the hypertensive patient?

“…2 However, the strength of the association between the MS and cardiovascular events is largely dependent on the definition and threshold used to define the MS and of the patients' characteristics, with one study also reporting a significant association for a blunted MS. 3 Few studies have also reported substantial ethnic differences in the degree of MS, a finding which can help understand the role of ethnic factors in cardiovascular risk assessment and identify the most effective measures to be implemented for preventing BP-related cardiovascular events (Table 1). [9][10][11] Although the major strength of the study by Gavin et al stands in the rigorous methodology employed to assess the MS, nonetheless the study is not free of some critical issues. One longitudinal study, based on mixed populations from Europe, Asia, and South America, anticipated some potential differences in the risk of cardiovascular events according to the ethnic group.…”

“…8 This methodology relies upon a line of best fit based on the entire recording and can independently estimate the power of the MS and the rate of the morning rise during the transition period, making no assumption about when the BP is rising. [9][10][11] Although the major strength of the study by Gavin (Table 1). [9][10][11] Although the major strength of the study by Gavin (Table 1).…”

“…This is relevant since the calculation of MS bears several unsolved and critical issues, particularly related to the methodology used for its calculation, as summarized in Table 2. [9][10][11] Although the major strength of the study by Gavin et al stands in the rigorous methodology employed to assess the MS, nonetheless the study is not free of some critical issues. First, the ABPM was performed in the Research Unit facility.…”

Суточный Профиль Артериального Давления У Детей С Хроническим Пиелонефритом И Хронической Болезнью Почек I–III Стадии

“…Although statistically significant between-groups differences in indices of BP morning surge were not obtained by a majority of comparisons, the fact of an increase in magnitude and velocity of BP morning surge in CKD children with reduced renal function deserves attention. It should be noted that the morning BP surge is mediated by rapid sympathetic nervous system activation with the development of vasoconstriction [7,22]. Also, in the morning, the endothelial function decreases, and the level of thrombogenic factors increases [23,24].…”

“…A number of studies have shown that high BP plays the role of an independent risk factor for rapid reduction in glomerular filtration rate (GFR) in patients with renal diseases [6][7][8][9]. BP monitoring is important for the management of patients with CKD, both for the conventional cardiovascular risk reduction and long-term preservation of kidney function [8].…”