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Morning hypertension: the strongest independent risk factor for stroke in elderly hypertensive patients

Kazuomi Kario1, Joji Ishikawa, Thomas G Pickering

  • 1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan. kkario@jichi.ac.jp

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|December 2, 2006
PubMed

Insights

Morning hypertension significantly increases stroke risk in older adults. Monitoring morning and evening blood pressure at home is crucial for early detection and treatment of hypertensive patients.

Area of Science:

  • Cardiology
  • Neurology
  • Gerontology

Background:

  • Stroke incidence is higher in the morning.
  • The specific impact of morning blood pressure (BP) on stroke risk in hypertensive individuals requires further investigation.

Purpose of the Study:

  • To investigate the relationship between morning BP levels and stroke prognosis in elderly hypertensive patients.
  • To identify the strongest BP predictor for stroke events.

Main Methods:

  • Prospective follow-up of 519 elderly hypertensive patients with ambulatory BP monitoring.
  • Analysis of stroke events over an average of 41 months.
  • Assessment of various BP parameters including morning SBP, 24-h BP, and morning-evening BP differences.

Main Results:

  • Morning systolic BP (SBP) was the strongest independent predictor of stroke events (RR 1.44 per 10 mmHg increase).
  • Both the average morning-evening SBP and the morning-evening SBP difference independently predicted stroke risk.
  • Morning hypertension (defined by specific morning-evening BP criteria) showed a 3.1-fold increased risk of stroke events compared to sustained hypertension.

Conclusions:

  • Morning hypertension is a critical independent predictor of future stroke events in elderly hypertensive patients.
  • Home monitoring of both morning and evening BP is recommended as an initial step in managing hypertensive patients.

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