Introduction; Morning hypertension is closely related to target organ damage and cardiovascular events. Only a few data exist about the baseline characteristics and clinical implications of morning hypertension in newly detected hypertensives.
Methods; We evaluated 267 newly detected hypertensive patients who had never taken anti-hypertensive medication. The enrolled patients measured their home blood pressures (BP) at least 7 days and their conventional office BP, central BP measured by radial artery tonometry and ambulatory BP were recorded. We analyzed their demographic data, laboratory data including echocardiography, carotid Doppler, ankle-brachial index and pulse wave velocity, and BP profiles. We defined ���morning hypertension��� as the morning BP 135/85 mmHg or higher with a morning-evening systolic or diastolic BP difference more than 10 mmHg in home BP monitoring.
Results; Twenty seven patients (10.1%) with morning hypertension showed a preponderance of older patients (52.6짹11.8 vs. 47.9짹11.7, p=0.047) and alcohol consumers (63.0% vs. 41.7%, p=0.034, OR=2.380). Morning hypertension group showed worse lipid profiles than control group. Echocardiographic parameters, such as mitral valve E velocity (60.4짹13.4 vs. 71.1짹15.9, p=0.028), E/A ratio (0.87짹0.24 vs. 1.07짹0.37, p=0.073), mitral valve deceleration time (230.4짹35.3 vs. 199.0짹54.9, p=0.057) and mitral annular E velocity in tissue Doppler imaging (6.04짹1.20 vs. 8.06짹2.30, p<0.001) and carotid intima-media thickness (0.89짹0.28 vs. 0.64짹0.17, p=0.013) were also unfavorable in morning hypertensives. Their Framingham risk scores for coronary heart disease were significantly higher than control group (12.8짹7.7 vs. 8.4짹6.4, p=0.004). The patients with morning hypertension showed higher home systolic pressure, higher home pulse rate and higher central diastolic pressure despite comparable office BP and pulse rate. In 24-hour ambulatory BP monitoring, they showed higher systolic BP and pulse rate during whole day long. The nocturnal BP dipping was comparable in two groups whereas the lowest nighttime systolic BP and the highest morning systolic BP were higher in morning hypertensives. There were more sustained hypertension and masked hypertension, and fewer normotension and white-coat hypertension among the patients with morning hypertension.
Conclusion; The patients with morning hypertension have worse clinical variables and poor BP profiles. So, we can suggest the potential relationship of morning hypertension and a poor cardiovascular outcome. The morning BP should be monitored at home for the optimal treatment of hypertension.