Strategies Against High Blood Pressure in the Early Morning

Abstract

Acute myocardial infarction and cerebrovascular disease reportedly show peak onset in the early morning, when blood pressure increases. The increase of blood pressure, or morning surge, may result from increased sympathetic activity reactive to arousal. The circadian pattern of vascular events is considered to be related to the morning surge in blood pressure, sympathetic activity, and hypercoagulability. Although there is no direct evidence indicating a causal relationship between the morning surge in blood pressure and vascular complications, it may be postulated that morning blood pressure surge is a factor which affects hypertensive complications. There may be two possible approaches to morning blood pressure surge; the pharmacodynamic and pharmacokinetic approach. On the basis of pharmacodynamics, drugs with adrenergic α–blocking actions are usually selected. From a pharmacokinetic view, it is essential to maintain blood concentration of a drug at the critical early morning period. On this point, use of long acting agents, changes in drug regimen and the development of a chronobiological system has been studied, with many studies reporting successful results in lowering morning blood pressure. Further study whether such kinds of treatments improve long term outcomes in hypertensive patients are desired.

• Morning surge
• Circadian rhythm
• Pharmacokinetics
• Chronopharmacology