title: Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study.
abstract: BACKGROUND
  Cardiovascular events occur most frequently in the morning hours. We prospectively studied the association between the morning blood pressure (BP) surge and stroke in elderly hypertensives.
  
  
  RESULTS
  We studied stroke prognosis in 519 older hypertensives in whom ambulatory BP monitoring was performed and silent cerebral infarct was assessed by brain MRI and who were followed up prospectively. The morning BP surge (MS) was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP. During an average duration of 41 months (range 1 to 68 months), 44 stroke events occurred. When the patients were divided into 2 groups according to MS, those in the top decile (MS group; MS > or =55 mm Hg, n=53) had a higher baseline prevalence of multiple infarcts (57% versus 33%, P=0.001) and a higher stroke incidence (19% versus 7.3%, P=0.004) during the follow-up period than the others (non-MS group; MS <55 mm Hg, n=466). After they were matched for age and 24-hour BP, the relative risk of the MS group versus the non-MS group remained significant (relative risk=2.7, P=0.04). The MS was associated with stroke events independently of 24-hour BP, nocturnal BP dipping status, and baseline prevalence of silent infarct (P=0.008).
  
  
  CONCLUSIONS
  In older hypertensives, a higher morning BP surge is associated with stroke risk independently of ambulatory BP, nocturnal BP falls, and silent infarct. Reduction of the MS could thus be a new therapeutic target for preventing target organ damage and subsequent cardiovascular events in hypertensive patients.
authors.affiliation: Department of Cardiology, Jichi Medical School, Tochigi, Japan. kkario@jichi.ac.jp
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Pickering
authors.forename: Yuji
authors.initials: Y
authors.lastname: Umeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.forename: Yoko
authors.initials: Y
authors.lastname: Hoshide
authors.forename: Masato
authors.initials: M
authors.lastname: Morinari
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Murata
authors.forename: Toshio
authors.initials: T
authors.lastname: Kuroda
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002544:Cerebral Infarction / Q000175:diagnosis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D015994:Incidence; D008297:Male; D010507:Periodicity; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents