The Clinical Significance of the Morning Blood Pressure Surge in Chronic Kidney Disease: A Systematic Review

Morning blood pressure surge (MBPS) is a circadian blood pressure phenomenon implicated in cardiovascular and renal risk. Patients with chronic kidney disease (CKD) frequently exhibit circadian BP disturbances, but the prognostic significance of MBPS in this population remains uncertain. This systematic review evaluated the association between MBPS and clinical outcomes in adults with established CKD. A comprehensive search of major electronic databases identified observational cohort studies assessing MBPS using 24-hour ambulatory blood pressure monitoring. Studies reporting cardiovascular events, renal outcomes, or mortality were included. Two cohort studies comprising 457 patients met eligibility criteria. In one study, elevated MBPS (≥35 mmHg) was independently associated with a higher risk of composite adverse outcomes (HR 3.12; 95% CI 1.10-9.13). In the second study, elevated MBPS predicted CKD progression (HR 2.35; 95% CI 1.20-4.63) but showed no significant association with cardiovascular events or mortality. Despite differences in MBPS definitions and outcome measures, both studies demonstrated that MBPS provides independent prognostic information. Current evidence, though limited, indicates that elevated MBPS is associated with adverse renal and composite clinical outcomes in CKD. These findings support the potential utility of ambulatory BP monitoring and circadian BP assessment in risk stratification. Larger prospective studies are needed to clarify cardiovascular implications and determine whether targeting MBPS can improve outcomes.