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Blood pressure surge on rising
Philippe Gosse1, Raphaël Lasserre, Catherine Minifié
1Service de Cardiologie/Hypertension Artérielle, Hopital Saint André, 1 rue Jean Burguet, 33075 Bordeaux, France. philippe.gosse@chu-bordeaux.fr
Insights
Morning blood pressure (BP) surges upon rising, increasing heart rate (HR). This BP elevation is linked to left ventricular hypertrophy and a higher risk of cardiovascular complications in hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Physiology
Background:
- Cardiovascular events often occur in the morning.
- This is potentially linked to the blood pressure (BP) surge upon waking.
- Understanding this phenomenon is crucial for managing hypertension.
Purpose of the Study:
- To measure BP and heart rate (HR) upon rising in untreated hypertensive patients.
- To compare these measurements with pre-rising values.
- To identify factors associated with significant changes in BP and HR.
Main Methods:
- 24-hour ambulatory BP monitoring was performed.
- BP upon rising was accurately measured using a position sensor.
- Left ventricular mass was assessed via echocardiography at baseline.
Main Results:
- A cohort of 507 untreated hypertensive patients was analyzed.
- Rising resulted in an average increase of 14 mmHg in systolic BP and 13 bpm in HR.
- This morning BP surge was associated with left ventricular hypertrophy and increased cardiovascular risk.
Conclusions:
- The study confirms a significant BP surge and HR acceleration upon rising in hypertensive individuals.
- This morning BP elevation is linked to overall BP variability, not mean 24-h BP.
- The surge is an independent predictor of cardiovascular complications, irrespective of age or average 24-h BP.
Objectives:
Since cardiovascular complications tend to occur more often in the morning, it is tempting to link this to the surge in blood pressure (BP) on rising. Our objective was to measure BP and heart rate (HR) on rising and compare values with those recorded immediately beforehand and seek variables related to marked changes in the two parameters in a cohort of initially untreated hypertensives.
Methods:
The 24-h ambulatory BP measurement along with an accurate measurement of the BP on rising (either manually or automatically from the device coupled with a position sensor) was obtained in untreated hypertensives. Left ventricular mass was measured with echocardiography at baseline. Patients were then treated and followed by their general physician and news was obtained at regular intervals.
Results:
A total of 507 patients with adequate recordings were included. Rising led to a mean increase of 14 mmHg in systolic blood pressure (SBP) and a 13 beats per minute (bpm) increase in HR. This elevation in BP on rising in the morning differed from the alteration in BP on normal changes in position. It was associated with left ventricular hypertrophy at baseline and an increased risk of future cardiovascular complications.
Conclusions:
Our study confirms the surge in BP on rising in the morning. This elevation in BP is accompanied by an acceleration in cardiac rhythm with no significant correlation between the two parameters. The increase in BP on rising was linked with the overall variability in BP, but was independent of the mean BP over 24 h. It was associated with an increased risk of cardiovascular complications independently of age and average 24-h SBP.
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