Cardiac implications of the morning surge in blood pressure in elderly hypertensive patients: relation to arising time.

Although morning surge in blood pressure has been shown to be associated with the occurrence of myocardial ischemic events and stroke, few studies have been done regarding its pathogenesis, probably because of a lack of method for the quantitative assessment of awakening time. We conducted an echocardiographic study and ambulatory blood pressure monitoring in 23 elderly hypertensive patients to evaluate the relationship between the hypertensive cardiac change and morning surge in blood pressure. Of note was that the time of arising from bed was assessed quantitatively by an activetracer equipped with an internal acceleration sensor to monitor the physical activity. The change in systolic blood pressure after arising from bed was correlated significantly with the left ventricular mass index (r = 0.51, P < .02) and the A/E ratio, which represents the diastolic function (r = 0.70, P < .01). In contrast, the change in systolic blood pressure before rising from bed was not correlated with any echocardiographic parameters. We conclude that the magnitude of morning surge in blood pressure after arising from bed was related with the severity of hypertensive target organ damage.