The morning blood pressure surge: Therapeutic implications

Abstract

Adverse cardiovascular events such as myocardialinfarction, stroke, arrhythmias, and sudden cardiacdeath are well known to follow a circadianpattern, peaking in the morning hours of 6 am to12 pm. Many physiologic factors have been shownto follow a circadian pattern and together maycreate an environment that promotes intraluminalthrombi formation. Blood pressure follows thispattern with a "dip" at night and an increaseon awakening. This morning surge may lead tohemodynamic forces that predispose patients toplaque rupture. The clinical impression of theseknown physiologic patterns associated withadverse cardiovascular events suggests that a stricttreatment schedule targeting this phenomenon isneeded. The goal of this review is to provide clinicianswith an overview, allowing for informeddecisions about chronotherapeutic formulationstailored to provide blood pressure controlthroughout the day and night. © 2008 Le Jacq.