Isolated Morning Hypertension is a Predictor of Cardiovascular Events in Treated and Well Controlled Hypertensive Patients.

Abstract

Introduction: The prognostic significance of isolated morning hypertension (IMH) in treated hypertensive patients remains unclear. Although overall blood pressure (BP) control is often considered adequate, morning BP surges may still pose cardiovascular risks.

Aim: To determine whether the presence of IMH in treated hypertensive patients with globally controlled BP is associated with an increased risk of cardiovascular events.

Methods: This cohort study included hypertensive patients on stable antihypertensive treatment for ≥ 4 weeks who underwent home blood pressure monitoring (HBPM) between September 1, 2008, and December 31, 2015. BP was measured in duplicate over four days (morning, afternoon, and evening) using an OMRON 705 CP device. IMH was defined as an average morning BP > 135 and/or 85 mmHg, despite overall mean BP < 135/85 mmHg. Patients were followed until April 30, 2020, for fatal and non-fatal cardiovascular and cerebrovascular events. Cox proportional hazards models were used to assess the prognostic value of IMH.

Results: A total of 925 patients were included, with a prevalence of IMH of 17.4% (95% CI 15.1-20%). During a median follow-up of 6.2 years, 126 cardiovascular events occurred. Compared to well-controlled hypertensive patients without IMH, those with IMH had a significantly higher risk of cardiovascular events after adjusting for sex, age, body mass index, number of antihypertensive drugs, smoking status, diabetes, and office BP (HR 1.6, 95% CI 1.1-2.2; p = 0.02).

Conclusions: IMH detected through HBPM was associated with an increased risk of fatal and non-fatal cardiovascular and cerebrovascular events in treated hypertensive patients with otherwise adequate global BP control. Monitoring and addressing IMH may be essential to further reducing cardiovascular risk.