title: Prognostic value of morning blood pressure surge in clinical events: a meta-analysis of longitudinal studies.
abstract: BACKGROUND
  Cardiovascular (CV) events tend to occur more often in the morning. Thus, morning blood pressure surge (MS) may be related to the risk of CV events. The results of several studies evaluating the prognostic value of MS are inconsistent. In this study, we conducted a systematic review and meta-analysis to summarize the significance of MS in predicting future CV events.
  
  
  METHODS
  Among the related literature, we discovered 7 eligible longitudinal studies that had evaluated MS and had followed 14,133 patients with a mean follow-up period of 7.1 years. We evaluated the predictive value of MS for future CV events, stroke, and all-cause mortality in this meta-analysis.
  
  
  RESULTS
  For subjects with higher pre-waking MS than those with lower pre-waking MS, the pooled relative risk (RR) of all-cause mortality, stroke, and total CV events were 1.20 (95% confidence interval [CI]: .85-1.70, P = .290; 4 studies), 1.20 (95% CI: .94-1.53, P = .146; 3 studies), and 1.24 (95% CI: .60-2.53, P = .562; 3 studies), respectively. For subjects with higher sleep-trough MS, the pooled RR of all-cause mortality was 1.29 (95% CI: 1.11-1.52, P = .001; 4 studies). No significant publication bias was observed.
  
  
  CONCLUSIONS
  Excess sleep-trough MS is a strong predictor for future all-cause mortality. Individuals with higher pre-waking MS showed a tendency for increased risk of CV outcomes, but the differences were insignificant.
authors.affiliation: Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jun-Chao
authors.initials: JC
authors.lastname: Xie
authors.affiliation: Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Han
authors.initials: H
authors.lastname: Yan
authors.affiliation: Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yan-Xin
authors.initials: YX
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: liuxy@tongji.edu.cn.
authors.forename: Xue-Yuan
authors.initials: XY
authors.lastname: Liu
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology
keywords: Morning blood pressure surge; cardiovascular risk; meta-analysis; prediction; stroke