What Causes Morning Hypertension?
The morning surge in BP is influenced by many pathophysiological factors, such as activity of the autonomic and renin-angiotensin- aldosterone systems and dietary sodium intake. Other alterations that occur during the early morning that can have a significant impact on increasing CV risk in this population include increased heart rate, vascular tone, blood viscosity, and platelet aggregability. With the advent of ambulatory blood pressure monitoring (ABPM), this technology has improved identification of patients with excessive morning surges and has facilitated assessment of antihypertensive agents that may be particularly effective in this subgroup of the hypertensive population.11,12 In the Japan Morning Surge-1 study, Ishikawa and colleagues used ABPM in 611 patients with morning hypertension to determine important patient-specific characteristics.13 The analysis showed that patients with morning hypertension are more likely to be of older age, as well as have a longer duration of h
