Published Online
on March 3, 2003

A more recent version of this article appeared on March 18, 2003

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Submitted on November 11, 2002
Accepted on December 10, 2002

Morning Surge in Blood Pressure as a Predictor of Silent and Clinical Cerebrovascular Disease in Elderly Hypertensives. A Prospective Study

Kazuomi Kario MD^*, Thomas G. Pickering MD, Yuji Umeda MD, Satoshi Hoshide MD, Yoko Hoshide MD, Masato Morinari MD, Mitsunobu Murata MD, Toshio Kuroda MD, Joseph E. Schwartz PhD, and Kazuyuki Shimada MD

From the Department of Cardiology (K.K., Y.U., S.H., Y.H., K.E., M. Morinari, M. Murata, T.K., K.S.), Jichi Medical School, Tochigi, Japan; The Zena and Michael A. Wiener Cardiovascular Center (K.K., T.G.P.), Mount Sinai School of Medicine; and the Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook, NY (J.E.S), Stony Brook, NY.

^* To whom correspondence should be addressed. E-mail: kkario{at}jichi.ac.jp.

Background--Cardiovascular events occur most frequently in the morning hours. We prospectively studied the association between the morning blood pressure (BP) surge and stroke in elderly hypertensives.

Methods and Results--We studied stroke prognosis in 519 older hypertensives in whom ambulatory BP monitoring was performed and silent cerebral infarct was assessed by brain MRI and who were followed up prospectively. The morning BP surge (MS) was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP. During an average duration of 41 months (range 1 to 68 months), 44 stroke events occurred. When the patients were divided into 2 groups according to MS, those in the top decile (MS group; MS 55 mm Hg, n=53) had a higher baseline prevalence of multiple infarcts (57% versus 33%, P=0.001) and a higher stroke incidence (19% versus 7.3%, P=0.004) during the follow-up period than the others (non-MS group; MS <55 mm Hg, n=466). After they were matched for age and 24-hour BP, the relative risk of the MS group versus the non-MS group remained significant (relative risk=2.7, P=0.04). The MS was associated with stroke events independently of 24-hour BP, nocturnal BP dipping status, and baseline prevalence of silent infarct (P=0.008).

Conclusions--In older hypertensives, a higher morning BP surge is associated with stroke risk independently of ambulatory BP, nocturnal BP falls, and silent infarct. Reduction of the MS could thus be a new therapeutic target for preventing target organ damage and subsequent cardiovascular events in hypertensive patients.

Key words: blood pressure • stroke • hypertension • cerebral infarction • cerebral ischemia

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Morning Surge in Blood Pressure

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