Recent study reported that morning hypertension was associated with worse cardiovascular outcomes in hypertensive patients. There are not enough studies about the inter-relationship between morning hypertension/nocturnal hypertension and central hemodynamics until now.Design and Method:
Ambulatory blood pressure monitoring and central BP were measured in 1062 consecutive subjects enrolled in Cardiovascular and Metabolic Disease Etiology Research Center - HIgh Risk Cohort (CMERC-HI, NCT02003781). Morning hypertension was defined as mean systolic BP (SBP) within 2 hours after awake > 135mmHg and nocturnal hypertension as mean night SBP > 120mmHg or diastolic BP (DBP ≥ 70mmHg. We divided morning hypertension into 3 subtypes. 1) morning normotension 2) morning hypertension without nocturnal hypertension and 3) morning hypertension with nocturnal hypertension.Results:
Morning hypertension was found in 494 (46.5%) patients and morning hypertension with nocturnal hypertension was in 403 (37.9%) patients. Central SBP/DBP (129/79 ± 21/11 vs. 116/75 ± 17/9mmHg, both p < 0.001), augmentation index (AIx, 30.6 ± 11.4 vs. 27.4 ± 13.3, p < 0.001) and carotid to femoral pulse wave velocity (cfPWV, 986 ± 245 vs. 887 ± 198 cm/s, p < 0.001) were higher in morning hypertension than in morning normotension. There were significant difference in central SBP (120/75 ± 16/8 vs. 116/75 ± 17/9mmHg, p = 0.027 for SBP, p = 0.746 for DBP) and cfPWV (932 ± 220 vs. 887 ± 198 cm/s, p = 0.049) not 24-hour SBP/DBP (p = 0.150/p = 0.219) between morning normotension and morning hypertension without nocturnal hypertension group. The morning hypertensive patients with nocturnal hypertension had higher central SBP/DBP (131/79 ± 21/11 vs. 120/75 ± 16/8mmHg, both p < 0.001) and cfPWV (998 ± 248 vs. 932 ± 220 cm/s, p = 0.020) compared to those without nocturnal hypertension.Conclusions:
We reported that morning hypertension, especially with nocturnal hypertension was related to higher central BP and increased arterial stiffness. Further studies for assessing whether morning hypertension with or without nocturnal hypertension relates to clinical outcomes should be warranted.