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(Circulation. 2003;107:1347.)
© 2003 American Heart Association, Inc.

Editorial

Morning Surge in Blood Pressure

Norman M. Kaplan, MD

From the University of Texas Southwestern Medical Center at Dallas, Dallas.

Correspondence to Norman M. Kaplan, MD, Department of Internal Medicine, Hypertension, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, CS 8.102, Dallas, TX 75390-8899.

Key Words: Key Words: • Editorials • blood pressure • stroke • sleep

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Some days it just doesn’t pay to get out of bed. As long recognized, there is an increased risk for heart attack, stroke, and sudden death in the first few hours of the morning.^1,2 In this issue of Circulation, Kario and colleagues have shown that, as for strokes, this risk is associated with a morning surge in blood pressure.³ Among the 519 elderly hypertensives in this study, the risk of stroke identified by brain MRI was 2.7-fold greater among the 55 who were in the top decile of the degree of morning surge of systolic blood pressure compared with the remaining subjects.

See p 1401

For their prospective study, blood pressures were measured by 24-hour ambulatory monitoring and the morning surge was defined as the difference between the mean systolic blood pressure during the 2 hours after waking and arising minus the mean systolic blood pressure during the hour that included the lowest blood pressure during sleep. This definition of the morning surge provided better discrimination than other definitions, including the difference between post-waking and preawakening levels as used by others.⁴ This definition should be used because the major component of the morning surge occurs only after arising from sleep and not during the time between awakening and arising.⁵

The risk of this morning surge has been seen by others,⁶ but the study by Kario et al³ is the largest and most definitive. The risk also has been noted after arising from afternoon siesta⁷ so it seems likely that . . . [Full Text of this Article]

Related Article:

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

Kazuomi Kario, Thomas G. Pickering, Yuji Umeda, Satoshi Hoshide, Yoko Hoshide, Masato Morinari, Mitsunobu Murata, Toshio Kuroda, Joseph E. Schwartz, and Kazuyuki Shimada
Circulation 2003 107: 1401-1406. [Abstract] [Full Text]

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				M. Bursztyn, T. Mengden, S. Uen, H. Vetter, R. Marfella, K. Esposito, P. Gualdiero, D. Guigliano, K. Kario, Y. Umeda, et al. Morning Blood Pressure Surge and the Risk of Stroke * Response Circulation, October 14, 2003; 108 (15): e110 - e111. [Full Text] [PDF]