Home blood pressure control is low during the critical morning hours in patients with hypertension: the SURGE observational study.
BACKGROUND
The morning blood pressure (BP) surge is associated with a peak increase in vascular events.


OBJECTIVE
The aim of this observational study was to evaluate morning BP control in treated hypertensive patients using home BP (HBP) monitoring and to compare these findings with clinic BP control.


METHODS
Clinic BP was measured twice during a 2-week period, prior to medication. Seated HBP was measured, using a BHS-validated device, three times per day over a 2-week period. Assessments included morning (06:00-11:59), lunch time (12:00-14:00) and evening (18:00-22:00) HBP control (all <135/85 mmHg) and clinic BP (<140/90 mmHg) control.


RESULTS
A total of 15618 patients were assessed. At baseline (Day 1 and Week 1), clinic BP control (<140/90 mmHg) and morning HBP control (<135/85 mmHg) were low: 23.6% and 21.9%, respectively. The percentage of patients with both clinic BP and morning HBP control was extremely low (8.5%). Similar values were obtained at lunch time (11.3%) and evening (9.9%). There was a slight improvement at the end of the second week, but values remained low. At final visit (Day 4 and Week 2), morning, lunch time and evening HBP control was observed in 31.8%, 42.2% and 36.4% of patients, respectively. Clinic BP control was observed in 41.7%.


CONCLUSIONS
Morning HBP control was low in this large hypertensive population. The improvement in BP control observed may be associated with inclusion in a study; this could indicate low medication compliance in general practices but may also be attributable to the use of agents that cannot sustain 24-hour BP control.
Hypertension Clinic, Department of Internal Medicine, Hospital Clinico, University of Valencia, Valencia, Spain. josep.redon@uv.es
Josep
J
Redon
Grzegorz
G
Bilo
Gianfranco
G
Parati
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination / Q000379:methods; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000959:Antihypertensive Agents