title: The morning blood pressure surge and all-cause mortality in patients referred for ambulatory blood pressure monitoring.
abstract: BACKGROUND
  Morning blood pressure surge (MS) is accepted to increase cardiovascular risk, but it is not clear how it should be defined. Because dipping on 24-h ambulatory blood pressure monitoring (ABPM) associates with improved outcome we hypothesized that MS will not predict mortality independent of dipping.
  
  
  METHODS
  We investigated a cohort of 2,627 patients referred for ABPM with available values for at least 1-h after awakening, and related them to all-cause mortality.
  
  
  RESULTS
  During 22,353 person-years of follow-up, 246 patients died. We used Cox proportional hazards models to explore mortality associated with different definitions of the MS. Only the "1-h" MS (difference between average blood pressure (BP) 1-h before and after awakening) was related to mortality: after multiple adjustments including 24-h systolic BP, those whose "1-h" MS was above median (>12 mm Hg) had mortality hazard ratio (HR) of 0.61, 95% CI: 0.47-0.79, P < 0.001. In predetermined subgroup analyses, nondippers (n = 1,039), had a highly significant MS-related decrease in mortality: HR 0.49, 95% CI: 0.34-0.73, P < 0.001, unlike dippers (n = 1,588), HR = 0.90, 95% CI: 0.60-1.34.
  
  
  CONCLUSIONS
  Among nondipping subjects referred for ABPM, the MS is associated with decreased mortality.
authors.affiliation: Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Sarah
authors.initials: S
authors.lastname: Israel
authors.forename: Ariel
authors.initials: A
authors.lastname: Israel
authors.forename: Iddo Z
authors.initials: IZ
authors.lastname: Ben-Dov
authors.forename: Michael
authors.initials: M
authors.lastname: Bursztyn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000959:Antihypertensive Agents