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Morning Surge in Blood Pressure in Hypertension: Clinical Relevance, Prognostic Significance, and Therapeutic Approach

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Special Issues in Hypertension

Abstract

Morning BP surge is one of the components of diurnal BP variability, and normal morning BP surge is physiological phenomenon. However, exaggerated morning BP surge is pathological. In addition to 24-h persisted pressure overload, dynamic BP variability from the nadir during sleep to peak early in the morning would contribute to cardiovascular continuum from early stage of subclinical vascular disease to the final trigger of cardiovascular events. Recent studies demonstrated that exaggerated morning BP surge is associated with target organ damages such as left ventricular hypertrophy, carotid atherosclerosis, arterial stiffness, albuminuria, and silent cerebrovascular disease, and with the future risk for cardiovascular disease, independently of 24-h BP level. Vascular diseases of both the small and large arteries are considered to be not only consequences but also the leading cause of exaggeration of morning BP surge, a circumstance giving rise to a vicious cycle in the cardiovascular continuum. Long-acting calcium channel blocker in both monotherapy or combination therapy with renin angiotensin system inhibitors, and bedtime administration of antihypertensives to suppress the morning BP surge would achieve more effective cardiovascular protection in the clinical practice for hypertensive patients. The definition and threshold of morning BP should be determined in future. 

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Kazuomi Kario

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Correspondence to Kazuomi Kario .

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Editors and Affiliations

  1. , Internal Medicine, American University of Beirut Medical Ce, Riad El Solh, Beirut, 1107-2020, Lebanon

    Adel E. Berbari

  2. Clinica Medica, Ospedale S. Gerardo, Università di Milano-Bicocca, V .Donizetti 106, Milano, Monza, 20133, Italy

    Giuseppe Mancia

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Kario, K. (2012). Morning Surge in Blood Pressure in Hypertension: Clinical Relevance, Prognostic Significance, and Therapeutic Approach. In: Berbari, A., Mancia, G. (eds) Special Issues in Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-2601-8_7

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  • DOI: https://doi.org/10.1007/978-88-470-2601-8_7

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