title: Relationship among morning blood pressure surge, 24-hour blood pressure variability, and cardiovascular outcomes in a white population.
abstract: Cardiovascular events have their greatest prevalence in the early morning period. Whether this is attributable to an arousal-dependent blood pressure (BP) increase is far from being clear. It is also not clear to what extent this phenomenon reflects overall 24-hour BP variability. In 2051 subjects (aged 25-74 years) representative of the population of Monza (Italy), we measured 24-hour ambulatory systolic BP (SBP) and calculated the difference between the 2-hour average values after morning arousal and the lowest 3 or average 2-hour values before arousal (morning BP surge 1 and 2, respectively). For either measure, we sought the relationship with a variety of indices of 24-hour SBP variability and collected information on (1) the occurrence of cardiovascular and all cause deaths during a follow-up of ≈16 years and (2) the appearance of echocardiographic left ventricular hypertrophy after 10 years from the baseline visit. Morning SBP surge 1 was directly related to indices of 24-hour SBP variability, including those made independent on the magnitude of the day-night SBP difference. There was a weak positive relationship between morning SBP surge 1 and the risk of cardiovascular and all-cause death, which disappeared after adjustment for confounders. This was the case also for development of left ventricular hypertrophy. Morning SBP surge 2 was smaller, inconsistently related to 24-hour SBP variability and not at all related to fatal events or new-onset left ventricular hypertrophy. In a white population, morning BP surge was not found to be an independent predictor of cardiovascular death, all-cause death, or development of high cardiovascular risk (as documented by new-onset cardiac damage) even when appropriately assessed by measures that reflect its association with 24-hour BP variability.
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.).
authors.forename: Michele
authors.initials: M
authors.lastname: Bombelli
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.).
authors.forename: Danilo
authors.initials: D
authors.lastname: Fodri
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.).
authors.forename: Elena
authors.initials: E
authors.lastname: Toso
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.).
authors.forename: Mario
authors.initials: M
authors.lastname: Macchiarulo
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.).
authors.forename: Matteo
authors.initials: M
authors.lastname: Cairo
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.).
authors.forename: Rita
authors.initials: R
authors.lastname: Facchetti
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.).
authors.forename: Raffaella
authors.initials: R
authors.lastname: Dell'Oro
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.).
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.affiliation: From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.) giuseppe.mancia@unimib.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000208:ethnology; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D014463:Ultrasonography; D044465:White People
keywords: blood pressure; blood pressure monitoring, ambulatory; cardiovascular diseases; morbidity; mortality