title: Diabetes and obesity are significant risk factors for morning hypertension: from Ibaraki Hypertension Assessment Trial (I-HAT).
abstract: OBJECTIVE
  Although morning hypertension (HT) has been identified as a major cardiovascular risk, susceptible populations remain unknown. This study aimed to clarify the relationship between morning HT and diabetes or obesity in a large-scale population.
  
  
  METHODS
  Clinic blood pressure (BP) and BP upon awakening were recorded in 2554 outpatients with HT who attended 101 clinics or hospitals for two weeks. Mean clinic and awakening BP>140/90 and >135/85 mmHg, respectively, were considered as HT. The patients were classified according to values for clinic and home BP, into normal BP, white coat HT, masked HT, and sustained HT.
  
  
  RESULTS
  Morning BP (mmHg) significantly and progressively elevated in the order of normal glucose tolerance, impaired glucose tolerance and diabetes (134.1 ± 12.2, 135.4 ± 13.1 and 137.5 ± 11.5; p<0.0001). The incidence of morning HT significantly increased and progressively in the same order (53.4%, 55.6%, 66.4%, p<0.0001). Morning BP was significantly higher among obese patients with diabetes than among non-obese and non-diabetic patients (138.8 ± 10.5, 133.1 ± 11.9, p<0.0001). In addition, the incidence of morning HT was significantly higher in obese diabetic patients than in non-obese and non-diabetic patients (73.0% vs. 49.9%, p<0.0001).
  
  
  CONCLUSIONS
  Diabetic or obese patients frequently have morning HT.
authors.affiliation: Mito Kyodo Hospital, Tsukuba University Hospital Mito Medical Center, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Toyama
authors.affiliation: Mito Kyodo Hospital, Tsukuba University Hospital Mito Medical Center, Japan. Electronic address: watanabe.s.gn@u.tsukuba.ac.jp.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Graduate School of Comprehensive Human Science, University of Tsukuba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyauchi
authors.affiliation: Mito Kyodo Hospital, Tsukuba University Hospital Mito Medical Center, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Kuroda
authors.affiliation: Mito Kyodo Hospital, Tsukuba University Hospital Mito Medical Center, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Ojima
authors.affiliation: Graduate School of Comprehensive Human Science, University of Tsukuba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: Graduate School of Comprehensive Human Science, University of Tsukuba, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Seo
authors.affiliation: Graduate School of Comprehensive Human Science, University of Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000150:complications; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000378:metabolism*; D016232:Endothelins / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000378:metabolism*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D016232:Endothelins
keywords: Cardiovascular risk; Diabetes; Endothelin; Home blood pressure measurement; Masked hypertension; Morning hypertension; Obesity