Morning increase in onset of ischemic stroke.

Marler, John R.; Price, Thomas R.; Clark, Gail; Muller, James E.; Robertson, Thomas; Mohr, J. P.; Hier, Daniel B.; Wolf, Philip A.; Caplan, Louis R.; Foulkes, Mary A.

doi:10.1161/01.str.20.4.473

Cited by 470 publications

(258 citation statements)

References 17 publications

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“…However, with the advancement and popularity of hospital-based, 24-hour, ambulatory BP monitoring devices as well as homebased self-monitoring devices, the importance of the use of ambulatory BP, especially those measurements taken at home have gained attention (1)(2)(3)(4)(5)(6)(7)(8). HBP obtained early in the morning at home by self-measurement is specifically highlighted as having a substantial impact on cardiovascular risk.…”

Section: State Of Bp Controlmentioning

confidence: 99%

“…HBP obtained early in the morning at home by self-measurement is specifically highlighted as having a substantial impact on cardiovascular risk. Indeed, many reports indicate a close association between HBP early in the morning and occurrence of cardiovascular events (6)(7)(8)10). In addition, cardiovascular risk is greater in patients with masked hypertension and/or those with poorcontrolled than in those with a well-controlled BP (18).…”

Section: State Of Bp Controlmentioning

confidence: 99%

“…This type of hypertension has a strong association with a morning rise in BP (sustained type morning hypertension) (21). In addition, cerebral stroke, coronary ischemia and sudden death are more likely to occur in the morning (6)(7)(8). GFR normally declines with age, at an estimated rate of 1 ml/min/year (22).…”

Section: Morning Hypertension and Organ Damagementioning

confidence: 99%

“…Indeed, HBP obtained early in the morning has been shown to have a substantial impact on the awareness of cardiovascular risks (1)(2)(3)(4)(5). In addition, many clinical reports indicate a close association between BP in the early morning and the occurrence of cardiovascular events such as myocardial infarction, cerebral apoplexy or sudden death (6)(7)(8). Recent investigations on the adequacy of BP control using HBP and office/clinic BP (OBP) performed in Japan clearly demonstrate that current antihypertensive therapy is inadequate to achieve the target goals (9,10).…”

Section: Introductionmentioning

confidence: 99%

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Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

et al. 2005

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Blood pressure (BP) measured at home early in the morning (HBP) has been recognized as a useful predictor for organ damage and has been viewed as an important therapeutic target in patients with hypertension. The present study was aimed to determine whether this notion holds true in patients with progressive renal disease.The study enrolled patients with mild to moderate renal impairment. They were all directed to record selfmeasured HBP to evaluate the adequacy of BP control. In addition to the conventional antihypertensive therapy, intensive treatment to more efficiently reduce elevated morning HBP was applied, especially in patients with diabetic nephropathy. The results were as follows:1) The status of BP control assessed using HBP and office/clinic BP (OBP) shows predominance of morning hypertension. The prevalence of patients with well-controlled systolic HBP was 38%, those with poorly-controlled HBP 30%, masked hypertension 20% and white coat hypertension 12%. 2) Early morning systolic HBP in diabetics was significantly higher than that in non-diabetics. However, when evaluated on systolic OBP, both groups were comparable. 3) Logistic regression analysis showed that the predictive variables to explain morning hypertension (more than 130 mmHg and increased systolic HBP) were age, amount of daily urinary protein excretion and left ventricular mass index (LVMI). 4) Following conventional therapy, intensive antihypertensive therapy consisting of calcium channel blockers (CCB) and/or diuretics given in the morning, and angiotensin receptor blockers (ARB) given in the evening, together with 1-blockers given at bedtime, efficaciously reduced elevated HBP in the morning. This result was associated with significant reduction in daily urinary protein excretion and in serum plasminogen-activator inhibitor (PAI-1) concentration. The present study indicates that, regardless of ongoing conventional antihypertensive therapy, the majority of patients with renal disease had morning hypertension, suggesting that these patients are at a higher risk for cardiovascular disease. For the purpose of improving morning hypertension, intensive treatments with combined CCB, ARB and 1-blockers could have substantial benefit on the morbidity and prognosis in patients with diabetic nephropathy. (Internal Medicine 44: 1239-1246, 2005)

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Section: State Of Bp Controlmentioning

confidence: 99%

Section: State Of Bp Controlmentioning

confidence: 99%

Section: Morning Hypertension and Organ Damagementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

et al. 2005

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“…These clinical events lished that pharmacological lowering of BP protects hypertensive patients across a broad age range have a peak incidence in the morning hours as they occur most often between 6 am and noon. [25][26][27][28] In one Summary study of asymptomatic hypertensives with ambulat-BP control has been shown to improve survival and ory ischemia (ST-segment depression) the 24-h to lessen the risk of pressure-related complications ambulatory BP burden was greater in hypertensives in hypertensive patients. However, once the with ambulatory ischemia compared to hypertendecision has been made to initiate antihypertensive sives without transient myocardial ischemia.…”

Section: Timing Of Cvd and MI Clinical Eventsmentioning

confidence: 99%

Therapeutic implications of the epidemiology and timing of myocardial infarction and other cardiovascular diseases

Flack

Yunis

1997

J Hum Hypertens

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Cardiovascular diseases (CVD) account for almost 50%their highest levels while coronary blood flow and of the 2 million deaths annually in the United States. plasma fibrinolytic activity are at their lowest levels of Coronary heart disease (CHD) (ie, myocardial infarction, the day. Moreover, BP rapidly rises from its nocturnal sudden death) account for the largest proportion (32%) nadir during the early morning hours. Prevention of of this mortality. Over the last 3 decades both CVD and pressure-related CVD events in hypertensive patients age-adjusted coronary death rates have fallen dramatiover the long term can be best accomplished by concally. However, crude CVD (and CHD) incidence is actutrolling BP throughout the 24 h time period with drugs ally increasing, almost exclusively as a function of risthat do not adversely impact (or favorably affect) other ing CVD incidence amongst older Americans. metabolic, neurohormonal, and hemostatic parameters. Population groups at highest for premature CVD compli-BP control (minimally to Ͻ140/90 mm Hg) may be partications include African-Americans, diabetics, men, cularly important in the early morning hours since elevsmokers, and those with high levels of single risk fac- ated BP and/or rapidly rising BP is a plausible biological tors (ie, stage III hypertension). Individuals with multiple trigger for the aforementioned CVD events. One effec-CVD risk factors as well as those with manifestations of tive strategy for achieving this goal is to utilize antihyblood pressure (BP)-related target-organ damage (TOD)pertensive drugs with long therapeutic half-lives. Such (ie, left ventricular hypertrophy, hypercreatinemia) are at agents will provide smooth whole-day BP control and an inordinately high risk for clinical events. CVD events also will minimize the loss of BP control during time do not randomly occur throughout the 24-h time period. period(s) between missed medication doses in the setThe peak incidence of myocardial infarction (MI), thromting of therapeutic non-compliance. Practitioners botic stroke, sudden cardiac death, and transient myoshould give due consideration to nocturnal adminiscardial ischemia is between 6 am and 12 noon. tration of antihypertensive drugs prescribed once-daily During the morning hours coinciding with the peak as a means of achieving more effective morning BP conincidence of CVD events, coronary vasomotor tone, trol. plasma catecholamines, and platelet aggregability are at

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Sleep Deprivation and Activation of Morning Levels of Cellular and Genomic Markers of Inflammation

Irwin¹

2006

Arch Intern Med

716

511

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Sleep loss induces a functional alteration of the monocyte proinflammatory cytokine response. A modest amount of sleep loss also alters molecular processes that drive cellular immune activation and induce inflammatory cytokines; mapping the dynamics of sleep loss on molecular signaling pathways has implications for understanding the role of sleep in altering immune cell physiologic characteristics. Interventions that target sleep might constitute new strategies to constrain inflammation with effects on inflammatory disease risk.

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Morning increase in onset of ischemic stroke.

Cited by 470 publications

References 17 publications

Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

Therapeutic implications of the epidemiology and timing of myocardial infarction and other cardiovascular diseases

Sleep Deprivation and Activation of Morning Levels of Cellular and Genomic Markers of Inflammation

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