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(Hypertension. 2007;49:771.)
© 2007 American Heart Association, Inc.

Editorial Commentaries

Vascular Damage in Exaggerated Morning Surge in Blood Pressure

Kazuomi Kario

From the Center of Excellence Program, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.

Correspondence to Kazuomi Kario, Center of Excellence Program, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan. E-mail kkario@jichi.ac.jp

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

Recent clinical studies demonstrated that an exaggerated morning blood pressure (BP) surge is a risk for cardiovascular events, such as ischemic and hemorrhagic stroke.^1–3 Simultaneously, neurohumoral factors and various cardiovascular risk factors are exaggerated in the morning. Although the precise molecular mechanisms remain unclear, exaggerated morning BP surge has been closely associated with other cardiovascular risk factors potentiated in the morning (Figure). The main mechanisms of morning BP surge and associated neurohumoral activation on cardiovascular disease consist of progression of cardiovascular remodeling and atherosclerosis, as well as direct effects of BP surges that may trigger cardiovascular events.

View larger version (50K):   Acute risk factors that exhibit diurnal variation are potentiated in the morning. Combined with chronic risk factors, which advance atherosclerotic process, these acute risk factors additively and synergically increased the risk for cardiovascular events in the morning..

An exaggerated morning BP surge may advance vascular remodeling from the larger arteries to the small resistance vessel through increased mechanical pressure and shear stress of an exaggerated fluctuation of blood flow on the vessel wall. In hypertensive patients, morning BP surge and time of morning BP variability in the morning were significantly correlated with increased carotid intima–media thickness, and these associations were independent of 24-hour BP levels.⁴ On the other hands, increased stiffness of large arteries increases BP variability through impaired baroreceptor sensitivity. This increase in BP variability is pronounced particularly in the morning, when compared with the other periods,⁵ leading to cardiac hypertrophy.⁶ In addition, small artery disease may also be associated . . . [Full Text of this Article]

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Hypertension 2007 49: 784-791. [Abstract] [Full Text] [PDF]