Understanding the Morning Rise in Blood Pressure

Abstract

1. The morning period has been recognized as the highest risk period of the day for cardiovascular events, particularly stroke and is also associated with a rapid surge in blood pressure. 2. Evidence now exists to show that the morning surge in blood pressure is an independent risk factor in some elderly hypertensive subjects. 3. However, methods to assess the contribution of the morning blood pressure surge from ambulatory recordings or home recordings, using clock times or times of waking, do not take into consideration the individual patterns of blood pressure change which can range from a rapid rise prior to or following waking to a slow increase over several hours. 4. In the present review we describe a novel method for determining the individual changes using a double logistic equation fitted to the individual pattern of blood pressure change. 5. Methods are presented to determine the rate of rise function over the morning period as well as predicting the change over a fixed time window which may be useful in refining the contribution of the blood pressure surge to cardiovascular risk. 6. Hypertensive people have an exaggerated rise in morning blood pressure as well as a greater rate of rise. 7. Antihypertensive drugs and dosing regimes are being developed which may be useful adjuncts to standard therapy for preventing morning hypertension and hopefully also reducing cardiovascular damage or events.

Predictors of Mean Arterial Pressure Morning Rate of Rise and Power Function in Subjects Undergoing Ambulatory Blood Pressure Recording

“…The principle involves the multiplication of the RoR by the amplitude of the rise which are calculated from our standard six parameter logistic equation [12]. The method is independent of the recorded waking time as we have previously shown these to be unreliable in predicting the peak in BP surge [23]. The novel power function is the first derivative of the logistic curve multiplied by the amplitude which is the day night difference between plateaus [14].…”

Cardiovascular Responses to Aversive and Nonaversive Stressors in Schlager Genetically Hypertensive Mice

“…9 These findings not only suggest that the hypertension observed is likely due to an overactive SNS, the pattern of night-time arousal activation is highly suggestive of the pattern associated with stress similar to that observed in human early morning BP surge. 3 Thus, we hypothesize that Schlager BPH/2J mice may respond considerably more in terms of BP rise than BPN/3J mice to a stressful stimulus.…”

A retrospective study of circadian and seasonal presentations of dogs with congestive heart failure: 119 cases (1997–2009)

“…For example, the body temperature of a person varies during a 24‐hour time frame with the trough occurring in the early morning and the peak in the late afternoon . People have an early morning rise in blood pressure from 5 am to 8 am , typically centered around the time of awakening . These rhythms are significant as they may underlie the pattern of heart disease presentations .…”