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Published on: April 23, 2021
Association of Morning Hypertension Subtype With Vascular Target Organ Damage and Central Hemodynamics
Jaewon Oh1, Chan Joo Lee1, In-Cheol Kim1
1Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Morning hypertension with nocturnal hypertension is linked to higher central blood pressure and arterial stiffness in high-risk patients. Further research is needed to determine its impact on clinical outcomes.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Medicine
Background:
- Morning hypertension is linked to adverse cardiovascular outcomes.
- The distinct effects of morning hypertension with versus without nocturnal hypertension on target organ damage remain unclear.
- This study investigates morning hypertension subtypes in high-risk cardiovascular disease patients.
Purpose of the Study:
- To determine the association of morning hypertension, with or without nocturnal hypertension, with vascular target organ damage.
- To assess the impact of morning hypertension subtypes on central hemodynamics.
- To identify differences in cardiovascular risk markers between morning hypertension subtypes.
Main Methods:
- 1070 high-risk patients underwent ambulatory blood pressure monitoring and central blood pressure measurement.
- Patients were categorized into three groups: morning normotension, morning hypertension without nocturnal hypertension, and morning hypertension with nocturnal hypertension.
- Central systolic/diastolic blood pressure and carotid-femoral pulse wave velocity were analyzed.
Main Results:
- Morning hypertension was present in 43.8% of patients; 34.9% had morning hypertension with nocturnal hypertension.
- The group with morning hypertension and nocturnal hypertension showed significantly higher central systolic/diastolic BP and pulse wave velocity compared to other groups.
- Morning hypertension with nocturnal hypertension independently predicted central hypertension and arterial stiffness but not vascular damage.
Conclusions:
- Morning hypertension, particularly when accompanied by nocturnal hypertension, is associated with elevated central blood pressure and increased arterial stiffness.
- Further investigation is warranted to ascertain the clinical outcomes associated with morning hypertension, with or without nocturnal hypertension.
- The findings highlight the importance of considering nocturnal blood pressure patterns in managing morning hypertension.
Background:
A recent study reported that morning hypertension is associated with poor cardiovascular outcomes in hypertensive patients. However, it is unclear whether morning hypertension associated with sustained nocturnal hypertension and that associated with morning blood pressure (BP) surge differ in terms of their effects on cardiovascular target organ damage and clinical outcomes. The present study aimed to determine the association of morning hypertension with/without nocturnal hypertension with vascular target organ damage and central hemodynamics in patients at high risk for cardiovascular disease.
Methods And Results:
Ambulatory BP monitoring was performed and central BP was measured in 1070 consecutive patients with high cardiovascular risk. We grouped morning hypertension into the following 3 subtypes: (I) morning normotension; (II) morning hypertension without nocturnal hypertension; and (III) morning hypertension with nocturnal hypertension. Morning hypertension was noted in 469 (43.8%) patients and morning hypertension with nocturnal hypertension was noted in 374 (34.9%) patients. The central systolic/diastolic BP and carotid to femoral pulse wave velocity were significantly higher in the subtype III group than in the subtype I and II groups (all P<0.001). Subtype III (versus subtype I) was an independent predictor of central hypertension and high-risk arterial stiffness (P<0.001 and P=0.018, respectively) but not vascular damage in a fully adjusted model (model Y).
Conclusions:
Morning hypertension, especially that associated with nocturnal hypertension, is related to high central BP and increased arterial stiffness. Further studies on whether morning hypertension with or without nocturnal hypertension is related to clinical outcomes should be performed.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02003781.
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