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Morning Hypertension in Treated Hypertensives: Baseline Characteristics and Clinical Implications

  • Lee, Ju-Hee (Cardiovascular Center of Chungbuk National University Hospital) ;
  • Bae, Jang-Whan (Cardiovascular Center of Chungbuk National University Hospital) ;
  • Park, Jung-Bae (Division of Medicine/Cardiology, Cheil General Hospital, Kwandong University, College of Medicine) ;
  • Park, Chang-Gyu (Cardiovascular Center, Korea University Guro Hospital) ;
  • Youn, Ho-Joong (Cardiovascular Center and Cardiology Division, College of Medicine, The Catholic University of Korea) ;
  • Choi, Dong-Ju (Cardiovascular Center, Seoul National University Bundang Hospital) ;
  • Ahn, Young-Keun (The Heart Center of Chonnam National University Hospital) ;
  • Shin, Joon-Han (Department of Cardiology, Ajou University School of Medicine) ;
  • Rim, Se-Joong (Division of Cardiology, Department of Internal Medicine, Yonsei University College Medicine) ;
  • Bae, Jang-Ho (Department of Cardiology, Heart Center, College of Medicine, Konyang University) ;
  • Kim, Dong-Woon (Cardiovascular Center of Chungbuk National University Hospital)
  • Published : 2011.12.30

Abstract

Background and Objectives: Morning hypertension is closely related to target organ damage and cardiovascular events. Little data is available concerning the baseline characteristics and comprehensive blood pressure analysis of hypertensive patients on treatment with morning hypertension. Subjects and Methods: We evaluated 1,087 hypertensive patients who had taken stable anti-hypertensive medication at least 6 months. The enrolled patients measured their home blood pressure for 7 days. Baseline characteristics and the laboratory data were analyzed. Morning hypertension was defined as a morning blood pressure $\geq$135/85 mm Hg and systolic or diastolic blood pressure difference between morning and evening exceeding 10 mm Hg. Results: One hundred seventy three patients with morning hypertension showed a preponderance of males, older patients, alcohol consumers, and greater waist circumference and waist-to-hip ratio despite the same body mass index. Impaired fasting glucose and metabolic syndrome were more prevalent in the patients with morning hypertension. The morning hypertensives took more anti-hypertensive drugs and displayed higher blood pressure in the clinic and at home. Conclusion: The worse clinical variables and relatively poorly controlled blood pressure of those with morning hypertension supports a potential relationship of morning hypertension with poor cardiovascular outcome. Morning blood pressure should be monitored at home for the optimal treatment of hypertension.

Keywords

References

  1. Manfredini R, Gallerani M, Portaluppi F, Fersini C. Relationships of the circadian rhythms of thrombotic, ischemic, hemorrhagic, and arrhythmic events to blood pressure rhythms. Ann N Y Acad Sci 1996;783:141-58. https://doi.org/10.1111/j.1749-6632.1996.tb26713.x
  2. Giles TD. Circadian rhythm of blood pressure and the relation to cardiovascular events. J Hypertens Suppl 2006;24:S11-6. https://doi.org/10.1097/01.hjh.0000220098.12154.88
  3. Ohkubo T, Imai Y, Tsuji I, et al. Prediction of mortality by ambulatory blood pressure monitoring versus screening blood pressure measurements: a pilot study in Ohasama. J Hypertens 1997;15:357-64. https://doi.org/10.1097/00004872-199715040-00006
  4. Asayama K, Ohkubo T, Kikuya M, et al. Prediction of stroke by home "morning" versus "evening" blood pressure values: the Ohasama Study. Hypertension 2006;48;737-43. https://doi.org/10.1161/01.HYP.0000240332.01877.11
  5. Kario K, Ishikawa J, Pickering TG, et al. Morning hypertension: the strongest independent risk factor for stroke in elderly hypertensive patients. Hypertens Res 2006;29:581-7. https://doi.org/10.1291/hypres.29.581
  6. Kario K, Pickering TG, Umeda Y, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003;107:1401-6. https://doi.org/10.1161/01.CIR.0000056521.67546.AA
  7. Gosse P, Cipriano C, Bemurat L, et al. Prognostic significance of blood pressure measured on rising. J Hum Hypertens 2001;15:413-7. https://doi.org/10.1038/sj.jhh.1001187
  8. Gosse P, Lasserre R, Minifie C, Lemetayer P, Clementy J. Blood pressure surge on rising. J Hypertens 2004;22:1113-8. https://doi.org/10.1097/00004872-200406000-00011
  9. Polonia J, Amado P, Barbosa L, et al. Morning rise, morning surge and daytime variability of blood pressure and cardiovascular target organ damage: a cross-sectional study in 743 subjects. Rev Port Cardiol 2005;24:65-78.
  10. Marfella R, Siniscalchi M, Nappo F, et al. Regression of carotid atherosclerosis by control of morning blood pressure peak in newly diagnosed hypertensive patients. Am J Hypertens 2005;18:308-18. https://doi.org/10.1016/j.amjhyper.2004.09.013
  11. Ikeda T, Gomi T, Shibuya Y, et al. Morning rise in blood pressure is a predictor of left ventricular hypertrophy in treated hypertensive patients. Hypertens Res 2004;27:939-46. https://doi.org/10.1291/hypres.27.939
  12. Shibuya Y, Ikeda T, Gomi T. Morning rise of blood pressure assessed by home blood pressure monitoring is associated with left ventricular hypertrophy in hypertensive patients receiving long-term antihypertensive medication. Hypertens Res 2007;30:903-11. https://doi.org/10.1291/hypres.30.903
  13. Ishikawa J, Hoshide S, Shibasaki S, et al. Relationship between morning hypertension identified by home blood pressure monitoring and brain natriuretic peptide and estimated glomerular filtration rate: the Japan Morning Surge 1 (JMS-1) Study. J Clin Hypertens (Greenwich) 2008;10:34-42. https://doi.org/10.1111/j.1524-6175.2007.07250.x
  14. Kamoi K, Miyakoshi M, Soda S, Kaneko S, Nakagawa O. Usefulness of home blood pressure measurement in the morning in type 2 diabetic patients. Diabetes Care 2002;25:2218-23. https://doi.org/10.2337/diacare.25.12.2218
  15. Ishikawa J, Kario K, Eguchi K, et al. Regular alcohol drinking is a determinant of masked morning hypertension detected by home blood pressure monitoring in medicated hypertensive patients with well-controlled clinic blood pressure: the Jichi Morning Hypertension Research (J-MORE) Study. Hypertens Res 2006;29:679-86. https://doi.org/10.1291/hypres.29.679
  16. Ishikawa J, Kario K, Hoshide S, et al. Determinants of exaggerated difference in morning and evening blood pressure measured by self-measured blood pressure monitoring in medicated hypertensive patients: Jichi Morning Hypertension Research (J-MORE) Study. Am J Hypertens 2005;18:958-65. https://doi.org/10.1016/j.amjhyper.2005.01.013
  17. Kawabe H, Saito I. Determinants of exaggerated difference in morning and evening home blood pressure in Japanese normotensives. Hypertens Res 2009;32:1028-31. https://doi.org/10.1038/hr.2009.138
  18. Tamaki S, Nakamura Y, Yoshino T, et al. The association between morning hypertension and metabolic syndrome in hypertensive patients. Hypertens Res 2006;29:783-8. https://doi.org/10.1291/hypres.29.783
  19. Shimizu M, Ishikawa J, Eguchi K, Hoshide S, Shimada K, Kario K. Association of an abnormal blood glucose level and morning blood pressure surge in elderly subjects with hypertension. Am J Hypertens 2009;22:611-6. https://doi.org/10.1038/ajh.2009.61
  20. Imai Y, Otsuka K, Kawano Y, et al. Japanese society of hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res 2003;26:771-82. https://doi.org/10.1291/hypres.26.771
  21. Lim S, Lee EJ, Koo BK, et al. Increasing trends of metabolic syndrome in Korea-based on Korean National Health and Nutrition Examination Surveys. J Korean Diabetes Assoc 2005;29:432-9.
  22. Pickering T. Recommendations for the use of home (self) and ambulatory blood pressure monitoring: American Society of Hypertension Ad Hoc Panel. Am J Hypertens 1996;9:1-11. https://doi.org/10.1016/0895-7061(95)00341-X
  23. Mancia G, De Backer G, Dominiczak A, et al. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007;25:1751-62. https://doi.org/10.1097/HJH.0b013e3282f0580f
  24. Mengden T, Chamontin B, Phong Chau N, Luis Palma Gamiz J, Chanudet X. User procedure for self-measurement of blood pressure: First International Consensus Conference on Self Blood Pressure Measurement. Blood Press Monit 2000;5:111-29.
  25. Kario K, White WB. Early morning hypertension: what does it contribute to overall cardiovascular risk assessment? J Am Soc Hypertens 2008;2:397-402. https://doi.org/10.1016/j.jash.2008.05.004

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