title: Blood pressure surge on rising.
abstract: OBJECTIVE
  Since cardiovascular complications tend to occur more often in the morning, it is tempting to link this to the surge in blood pressure (BP) on rising. Our objective was to measure BP and heart rate (HR) on rising and compare values with those recorded immediately beforehand and seek variables related to marked changes in the two parameters in a cohort of initially untreated hypertensives.
  
  
  METHODS
  The 24-h ambulatory BP measurement along with an accurate measurement of the BP on rising (either manually or automatically from the device coupled with a position sensor) was obtained in untreated hypertensives. Left ventricular mass was measured with echocardiography at baseline. Patients were then treated and followed by their general physician and news was obtained at regular intervals.
  
  
  RESULTS
  A total of 507 patients with adequate recordings were included. Rising led to a mean increase of 14 mmHg in systolic blood pressure (SBP) and a 13 beats per minute (bpm) increase in HR. This elevation in BP on rising in the morning differed from the alteration in BP on normal changes in position. It was associated with left ventricular hypertrophy at baseline and an increased risk of future cardiovascular complications.
  
  
  CONCLUSIONS
  Our study confirms the surge in BP on rising in the morning. This elevation in BP is accompanied by an acceleration in cardiac rhythm with no significant correlation between the two parameters. The increase in BP on rising was linked with the overall variability in BP, but was independent of the mean BP over 24 h. It was associated with an increased risk of cardiovascular complications independently of age and average 24-h SBP.
authors.affiliation: Service de Cardiologie/Hypertension Artérielle, Hopital Saint André, 1 rue Jean Burguet, 33075 Bordeaux, France. philippe.gosse@chu-bordeaux.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Gosse
authors.forename: Raphaël
authors.initials: R
authors.lastname: Lasserre
authors.forename: Catherine
authors.initials: C
authors.lastname: Minifié
authors.forename: Philippe
authors.initials: P
authors.lastname: Lemetayer
authors.forename: Jacques
authors.initials: J
authors.lastname: Clementy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013997:Time Factors