Association between morning blood pressure surge and cardiovascular remodeling in treated elderly hypertensive subjects.

BACKGROUND: It has remained unclear whether or not morning blood pressure (BP) surge (MS) is associated with cardiovascular remodeling in elderly (> or =60 years) hypertensive patients being treated by antihypertensive medications.
METHODS: In this cross-sectional study (n = 197; mean 74.6 years; 37% men), we evaluated the association between MS, defined as the highest quartile of morning BP increase from sleep (> or =48 mm Hg; n = 49), and extent of cardiac hypertrophy and carotid artery intima-media thickness (IMT).
RESULTS: Although there were no differences in 24-h BP levels and the number of prescribed antihypertensive medications between MS and non-MS group, the use of thiazide diuretics was more frequent in MS group than non-MS group (35% vs. 19%; P < 0.05). The MS group had significantly higher levels of left ventricular mass index (LVMI) and internal-carotid artery (ICA)-IMT than the non-MS group (both P < 0.01), independent of 24-h BP levels, daytime BP variability, the degree of nocturnal BP decline, the plasma low-density lipoprotein levels, and the use of diuretics. Even in subjects with a well-controlled 24-h BP level (<130/80 mm Hg; n = 75), these relationships were similar. A multiple logistic regression analysis showed that the presence of MS was an independent determinant of LV hypertrophy (LVH) (> or =125 g/m(2) in men and > or =110 g/m(2) in women) and assignment to the highest quartile of ICA-IMT (both P < 0.05).
CONCLUSIONS: The MS in subjects being treated with antihypertensive medications was significantly associated with cardiovascular remodeling, independently of 24-h BP level, daytime BP variability, and nocturnal BP decline.