Morning Blood Pressure Surge and the Risk of Stroke

نویسندگان

  • Giuseppe Maiolino
  • Gian Paolo Rossi
  • Dennis M. McNamara
  • Maninder Bedi
  • Richard Holubkov
  • Ravi Ramani
  • Karen Janosko
  • Michael Mathier
  • Guy A. MacGowan
  • Srinivas Murali
  • Arthur M. Feldman
  • Barry London
چکیده

of Stroke To the Editor: I read with great interest the important study of Kario et al1 in the March 18th issue about morning blood pressure surge and the risk of stroke. I would like to point out that the blood pressure surge does not occur solely on awakening in the morning. My colleagues and I2 as well as others3 have found that blood pressure surges also occur after the afternoon nap, also known as the siesta. As noted in the accompanying editorial, we have also described that practice of the siesta may be associated with doubled mortality in the elderly.4 More recently, two independent groups in Greece have found people in whom the siesta is prevalent and in whom a second peak of stroke corresponds to awakening from the siesta.3,5 The unaccounted-for siesta may be one cause of misclassification of dipping; another is nocturnal awakening, the siesta’s nocturnal mirror. Many older individuals such as the cohort of Kario et al,1 wake up at night, sometimes several times (especially men with prostatism). If their nocturnal awake blood pressure measurements were included in the nocturnal average, as occurs when such awakenings are not accounted for, major misclassification would occur.6 Such misclassification would bias the night’s blood pressure, lack of dipping (or extreme dipping), and the subsequent blood pressure surge on awakening. As this surge may be extremely important as pointed out by Kario et al,1 it should be appropriately evaluated. Until more precise tools are widely available, estimation by using patients’ diaries is a simple, easy, inexpensive, and universally available tool for such evaluation. Last but not least, it is well accepted by patients and increases their confidence in the analysis extracted from the little box.

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منابع مشابه

Morning surge in blood pressure.

Some days it just doesn’t pay to get out of bed. As long recognized, there is an increased risk for heart attack, stroke, and sudden death in the first few hours of the morning.1,2 In this issue of Circulation, Kario and colleagues have shown that, as for strokes, this risk is associated with a morning surge in blood pressure.3 Among the 519 elderly hypertensives in this study, the risk of stro...

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Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study.

There is continuing controversy over whether the pattern of circadian blood pressure (BP) variation that includes a nocturnal decline in BP and a morning pressor surge has prognostic significance for stroke risk. In this study, we followed the incidence of stroke in 1430 subjects aged > or =40 years in Ohasama, Japan, for an average of 10.4 years. The association between stroke risk and the pat...

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Morning blood pressure surge and the risk of stroke.

of Stroke To the Editor: I read with great interest the important study of Kario et al1 in the March 18th issue about morning blood pressure surge and the risk of stroke. I would like to point out that the blood pressure surge does not occur solely on awakening in the morning. My colleagues and I2 as well as others3 have found that blood pressure surges also occur after the afternoon nap, also ...

متن کامل

Impact of the Morning Surge in Blood Pressure

Through ambulatory blood pressure (BP) monitoring, we know that BP usually follows a distinct circadian rhythm, characterized by a nocturnal decline during sleep of 10% to 30%, followed by a moderate-to-marked increase coinciding with the time of awakening.1 For 2 decades, there has been great interest in the early morning period by preventive cardiologists and hypertension specialists, because...

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Additional impact of morning haemostatic risk factors and morning blood pressure surge on stroke risk in older Japanese hypertensive patients.

AIMS Stroke events occur most frequently in the morning hours. Impaired haemostatic activity and morning blood pressure (BP) surge, defined as the morning BP increase from sleep, have individually been associated with stroke risk in general or hypertensive populations. However, their combined impact on the risk of a stroke remains unknown. METHODS AND RESULTS A total of 514 hypertensive patie...

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The risk of waking-up: impact of the morning surge in blood pressure.

Through ambulatory blood pressure (BP) monitoring, we know that BP usually follows a distinct circadian rhythm, characterized by a nocturnal decline during sleep of 10% to 30%, followed by a moderate-to-marked increase coinciding with the time of awakening.1 For 2 decades, there has been great interest in the early morning period by preventive cardiologists and hypertension specialists, because...

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تاریخ انتشار 2003