The Risk of Waking-Up
2010; Lippincott Williams & Wilkins; Volume: 55; Issue: 4 Linguagem: Inglês
10.1161/hypertensionaha.109.148908
ISSN1524-4563
Autores Tópico(s)Climate Change and Health Impacts
ResumoHomeHypertensionVol. 55, No. 4The Risk of Waking-Up Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBThe Risk of Waking-UpImpact of the Morning Surge in Blood Pressure William B. White William B. WhiteWilliam B. White From the Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Conn. Originally published8 Mar 2010https://doi.org/10.1161/HYPERTENSIONAHA.109.148908Hypertension. 2010;55:835–837Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: March 8, 2010: Previous Version 1 Through ambulatory blood pressure (BP) monitoring, we know that BP usually follows a distinct circadian rhythm, characterized by a nocturnal decline during sleep of 10% to 30%, followed by a moderate-to-marked increase coinciding with the time of awakening.1 For >2 decades, there has been great interest in the early morning period by preventive cardiologists and hypertension specialists, because it became evident that the onset of acute events, including sudden death, myocardial infarction, and stroke peak in the first 4 to 6 hours postawakening.2,3 Because BP, heart rate, and these cardiovascular events all follow the same temporal pattern, it has been suspected that a pathophysiological relationship exists between hemodynamic aberrations, such as the early morning BP surge and vascular damage.3Previous researchers have characterized the morning BP surge associated with increased target organ injury.3,4 Risk factors for a profile of excessive early morning hypertension include older age, excessive alcohol and/or smoking, longer sleep times and later awakening times, cold weather climates, and day of the week (primarily Monday!).5,6 Several studies performed in the past decade have found significant relations among the early morning BP surge and vascular disease,7 cardiac hypertrophy,4 and white matter lesions of the brain.6,8 Prospective studies in Japanese individuals8,9 have demonstrated a clinical impact of the early morning BP surge in predicting cardiovascular events. In one such cohort with ≈3.5 years of follow-up, for each 10-mm Hg increase in the early morning systolic BP surge obtained at baseline, the risk of stroke increased by 22%.8 Of note, this change of BP on arising predicted cardiovascular events independently of age, the average 24-hour systolic BP, and antihypertensive therapy. In a separate population in Ohasama, Japan, that had a 10-year median follow-up period,9 a large early morning BP surge was associated with the development of hemorrhagic stroke. Furthermore, in a smaller cohort study in France,10 a higher cardiovascular morbidity and mortality rate was observed in patients with the highest morning BP surge compared with those patients in the lowest morning BP surge group.Thus, previous studies have suggested a parallel relationship between the early morning BP surge and cardiovascular outcomes but have been lacking in event numbers and enough statistical power to clarify at just what level of the morning BP surge the risk will appear to become excessive. In this issue of Hypertension, Yi et al11 have used the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome to address these questions. It is clear that their analyses have more advantages than previous studies: first, the population is large and heterogenous (5645 people, and more than half are women from 8 countries on 3 continents); second, the follow-up period and event numbers are substantially greater than all of the previous studies with 11.4 years of median follow-up and >600 cardiovascular events. The investigators used 2 different definitions of the morning surge in BP; the first was called the "sleep-through morning surge" and was defined as the difference between the morning pressure during the first 2 hours after awakening and the average of the lowest nighttime BP. This was similar to the definition used by Kario et al8 in their seminal description of the impact of the morning BP surge on stroke events in an older Japanese cohort. The second definition was the "preawakening morning surge" and was the calculated difference between the morning BP during the first 2 hours after awakening and the BP during the first 2 hours before awakening. The top decile for these 2 definitions of morning BP surge was 37 and 28 mm Hg, respectively. In addition, the absolute morning surge in BP was 145.8 versus 123.7 mm Hg in those subjects who were in the 90th percentile versus those below the 90th percentile using the systolic sleep-through morning surge definition. In general, the trends for the 2 methods were similar: the morning BP surge was associated with a 30% to 45% increase in hazard for cardiovascular events. Of note, both definitions were fairly robust and similar for cardiac events but not for stroke events. The reason for this is unclear, but the authors did note demographic differences, because subjects in Asian countries were at a significantly higher risk for hemorrhagic stroke in the top morning surge decile but not for ischemic strokes, a finding at odds with the study by Kario et al.8Of interest from the clinical perspective is the analysis of Yi et al11 to determine the "cutoff' point at which cardiovascular harm begins to occur. Using both definitions, the authors suggest that a systolic morning BP surge by either definition of 12 years ago.12 The Controlled Onset Verapamil Investigation for Cardiovascular Endpoints Trial was a 17 000-patient study that defined morning cardiovascular events as those occurring in the first 6 hours postawakening and originally should have had enough statistical power to evaluate this prespecified outcome on targeted versus nontargeted therapy. Unfortunately, because of premature discontinuation of the trial 3 years early by the study sponsor, there were not nearly enough events to make any assessment of the early morning event outcomes.It seems unlikely that another large-scale trial will be conducted to evaluate whether reduction of the morning surge in BP will reduce cardiovascular morbidity and mortality because, that trial would have to have an enormous sample size and be carried out for many years at a substantial cost. There are, however, a number of studies that demonstrate that it may not be difficult to intervene in morning BP surge values with targeted antihypertensive therapies.13,14 α-Adrenergic blockade at bedtime13 may be an effective means to both lower the morning BP surge and reduce left ventricular mass index, as well as microalbuminuria, in patients with uncontrolled "morning hypertension." In addition, renin-angiotensin blocking agents that maintain pharmacodynamic effects into the early morning period have been shown to have a significant effect on the morning surge in BP.14 Because the early morning period coincides with the end of the dosing period of once-daily medications, attenuation of antihypertensive efficacy is relatively common. On the basis of the results of this important new study by Yi et al,11 more scrutiny should be given to control of the early morning BP, especially in patients at high risk for cardiovascular diseases and those who continue to smoke cigarettes.The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.Sources of FundingThis work was supported by National Institutes of Health grants RO1 AG022092 and 5R01 DA24667-2 and the Donaghue Medical Research Foundation (West Hartford, CT).DisclosuresNone.FootnotesCorrespondence to William B. White, Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030-3940. E-mail [email protected] References 1 White WB. Clinical assessment of early morning blood pressure in patients with hypertension. Prev Cardiol. 2007; 10: 210–214.CrossrefMedlineGoogle Scholar2 Muller JE, Ludmer P, Willich SN, Tofler GH, Aylmer G, Klangos I, Stone PH. Circadian variation in the frequency of sudden cardiac death. Circulation. 1987; 75: 131–138.CrossrefMedlineGoogle Scholar3 Kario K, White WB. Early morning hypertension: what does it contribute to overall cardiovascular risk assessment? J Am Soc Hypertens. 2008; 2: 397–402.CrossrefMedlineGoogle Scholar4 Gosse P, Ansoborlo P, Lemetayer P, Clementy J. Left ventricular mass is better correlated with arising blood pressure than with office or occasional blood pressure. Am J Hypertens. 1997; 10: 505–510.CrossrefMedlineGoogle Scholar5 Modesti PA, Morabito M, Bertolozzi I, Massetti L, Panci G, Lumachi C, Giglio A, Bilo G, Caldara G, Lonati L, Orlandini S, Maracchi G, Mancia G, Gensini GF, Parati G. Weather related changes in 24-hour blood pressure profile: effects of age and implications for hypertension management. Hypertension. 2006; 47: 155–161.LinkGoogle Scholar6 Murakami S, Otsuka K, Kubo Y, Shinagawa M, Yamanaka T, Ohkawa S, Kitaura Y. Repeated ambulatory monitoring reveals a Monday morning surge in blood pressure in a community dwelling population. Am J Hypertens. 2004; 17: 1179–1183.CrossrefMedlineGoogle Scholar7 Marfella R, Siniscalchi M, Nappo F, Gualdiero P, Esposito K, Sasso FC, Cacciapuoti F, Di Filippo C, Rossi F, D'Amico M, Giugliano D. Regression of carotid atherosclerosis by control of morning blood pressure peak in newly diagnosed hypertensive patients. Am J Hypertens. 2005; 18: 308–318.CrossrefMedlineGoogle Scholar8 Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, Murata M, Kuroda T, Schwartz JE, Shimada K. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular diseases in elderly hypertensives: a prospective study. Circulation. 2003; 107: 1401–1406.LinkGoogle Scholar9 Metoki H, Ohkubo T, Kikoya M, Asayama K, Obara T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama Study. Hypertension. 2006; 47: 149–154.LinkGoogle Scholar10 Gosse P, Lasserre R, Minifie C, Lemetayer P, Clementy J. Blood pressure surge on rising. J Hypertens. 2004; 22: 1113–1118.CrossrefMedlineGoogle Scholar11 Yi Y, Thijs L, Hansen TW, Kikuya M, Boggia J, Richart T, Metoki H, Ohkubo T, Torp-Pedersen C, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Sandoya E, Kawecka-Jaszcz K, Ibsen H, Imai Y, Wang J, Staessen JA, for the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes Investigators. Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension. 2010; 55: 1040–1048.LinkGoogle Scholar12 Black HR, Elliott WJ, Grandits G, Grambasch P, Lucente T, White WB, Neaton JD, Grimm RH Jr, Hansson L, Lacourciere Y, Muller J, Sleight P, Weber MA, Williams G, Wittes J, Zanchetti A, Anders RJ, for the CONVINCE Research Group. Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular Endpoints (CONVINCE) Trial. JAMA. 2003; 289: 2073–2082.CrossrefMedlineGoogle Scholar13 Matsui Y, Eguchi K, Shibasaki S, Ishikawa J, Hoshide S, Pickering TG, Shimada K, Kario K. Effect of doxazosin on the left ventricular structure and function in morning hypertensive patients: the Japan Morning Surge 1 Study. J Hypertens. 2008; 26: 1463–1471.CrossrefMedlineGoogle Scholar14 White WB, Weber MA, Davidai G, Neutel JM, Bakris GL, Giles T. Ambulatory blood pressure monitoring in the primary care setting: assessment of therapy on the circadian variation of blood pressure from the MICCAT-2 Trial. Blood Press Monit. 2005; 10: 157–163.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Tian L, Wang F, Wu J and Lv Y (2021) Study on the Synthesis of Charge Transfer Complex of Nifedipine and Tetracyanoethylene, IOP Conference Series: Earth and Environmental Science, 10.1088/1755-1315/661/1/012028, 661:1, (012028), Online publication date: 1-Feb-2021. Ibrahim I, Abdel-Kareem A, Mahfouz R and Shehata I (2021) The Association Between Morning Blood Pressure Surge and Cardiovascular Disease in Normotensive Type 2 Diabetic Patients: Observational Analytical Study in the Form of a Cross-Sectional Study, SN Comprehensive Clinical Medicine, 10.1007/s42399-021-00797-4, 3:4, (955-963), Online publication date: 1-Apr-2021. Zuo H, Song X, Yang H, Deng L and Wang J (2019) Early morning home blood pressure control among treated patients with controlled office blood pressure, The Journal of Clinical Hypertension, 10.1111/jch.13736, 21:12, (1823-1830), Online publication date: 1-Dec-2019. Koc A, Gorgulu F, Donmez Y and Icen Y (2018) There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima–media thickness in hypertensive patients, Journal of Medical Ultrasonics, 10.1007/s10396-018-0877-y, 45:4, (597-603), Online publication date: 1-Oct-2018. Manfredini R and Fabbian F (2017) A pill at bedtime, and your heart is fine? Bedtime hypertension chronotherapy: An opportune and advantageous inexpensive treatment strategy, Sleep Medicine Reviews, 10.1016/j.smrv.2016.08.006, 33, (1-3), Online publication date: 1-Jun-2017. May R, Seibert G, Sanchez-Gonzalez M, Fitzgerald M and Fincham F (2016) Dispositional self-control: relationships with aerobic capacity and morning surge in blood pressure, Stress, 10.1080/10253890.2016.1260543, 20:1, (46-52), Online publication date: 2-Jan-2017. Alpaydin S, Turan Y, Caliskan M, Caliskan Z, Aksu F, Ozyildirim S, Buyukterzi Z, Kostek O and Muderrisoglu H (2017) Morning blood pressure surge is associated with carotid intima-media thickness in prehypertensive patients, Blood Pressure Monitoring, 10.1097/MBP.0000000000000252, 22:3, (131-136), Online publication date: 1-Jun-2017. Hodgkinson J, Tucker K, Martin U, Beesley L and McManus R (2015) The use of ambulatory blood pressure measurement, British Journal of Hospital Medicine, 10.12968/hmed.2015.76.11.631, 76:11, (631-637), Online publication date: 2-Nov-2015. Isegawa K, Hirooka Y, Kishi T, Yasukawa K, Utsumi H and Sunagawa K (2014) Benefit of azilsartan on blood pressure elevation around rest-to-active phase in spontaneously hypertensive rats, Clinical and Experimental Hypertension, 10.3109/10641963.2014.897721, 37:1, (45-50), Online publication date: 2-Jan-2015. Kishi T, Hirooka Y and Sunagawa K (2015) Brain Angiotensin II Type 1 Receptor Blockade Improves Dairy Blood Pressure Variability via Sympathoinhibition in Hypertensive Rats, International Journal of Hypertension, 10.1155/2015/759629, 2015, (1-7), . Yoda K, Inaba M, Hamamoto K, Yoda M, Tsuda A, Mori K, Yamada S, Emoto M, Koyama H and Imanishi Y (2014) Association Between Glycemic Control and Morning Blood Pressure Surge With Vascular Endothelial Dysfunction in Type 2 Diabetic Patients, Diabetes Care, 10.2337/dc13-1102, 37:3, (644-650), Online publication date: 1-Mar-2014. Qin X, Zhang Q, Yang S, Sun Z, Chen X and Huang H (2014) Blood Pressure Variability and Morning Blood Pressure Surge in Elderly Chinese Hypertensive Patients, The Journal of Clinical Hypertension, 10.1111/jch.12333, 16:7, (511-517), Online publication date: 1-Jul-2014. Suh M, Barksdale D and Logan J (2014) Morning Blood Pressure Surge and Nighttime Blood Pressure in Relation to Nocturnal Sleep Pattern and Arterial Stiffness, Journal of Cardiovascular Nursing, 10.1097/JCN.0b013e318291ee43, 29:2, (E10-E17), Online publication date: 1-Mar-2014. O'Brien E and Turner J (2012) Assessing Blood Pressure Responses to Noncardiovascular Drugs: The Beneficial Role of Ambulatory Blood Pressure Monitoring, The Journal of Clinical Hypertension, 10.1111/jch.12023, 15:1, (55-62), Online publication date: 1-Jan-2013. White W (2012) "The Nighttime Might be the Right Time" for Cardiovascular Event Prediction, Hypertension, 60:1, (8-9), Online publication date: 1-Jul-2012. Kario K (2011) Are melatonin and its receptor agonist specific antihypertensive modulators of resistant hypertension caused by disrupted circadian rhythm?, Journal of the American Society of Hypertension, 10.1016/j.jash.2011.03.006, 5:5, (354-358), Online publication date: 1-Sep-2011. Palatini P and Grassi G (2011) The morning blood pressure surge, Journal of Hypertension, 10.1097/HJH.0b013e32834d3df6, 29:12, (2316-2319), Online publication date: 1-Dec-2011. KARIO K (2011) , Rinsho yakuri/Japanese Journal of Clinical Pharmacology and Therapeutics, 10.3999/jscpt.42.107, 42:2, (107-108), . Kario K (2010) Morning Surge in Blood Pressure and Cardiovascular Risk, Hypertension, 56:5, (765-773), Online publication date: 1-Nov-2010. April 2010Vol 55, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/HYPERTENSIONAHA.109.148908PMID: 20212265 Originally publishedMarch 8, 2010 PDF download Advertisement SubjectsClinical Studies
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