Morning Surge in Blood Pressure as a Predictor of Silent and Clinical Cerebrovascular Disease in Elderly Hypertensives
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To the Editor:
We read with interest the paper by Kario et al,1 indicating that an excessive morning surge in blood pressure is a predictor of subsequent stroke in a sample population of elderly Japanese hypertensives.
On one hand, the evident diurnal variation in the onset of many acute cardiovascular events, eg, myocardial infarction, angina, cardiac arrest, sudden death, and pulmonary embolism, is closely related to the circadian pattern of blood pressure.2 On the other, there is no doubt that hypertension plays a key role as a risk factor for cerebrovascular accidents. However, recent studies from our group found that patients with and without hypertension had the same 24-hour pattern of onset of both ischemic3 and hemorrhagic4 stroke, characterized by a morning peak.
Moreover, other cardiovascular events, eg, acute aortic dissection, show an evident …