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Association of Morning Hypertension Subtype With Vascular Target Organ Damage and Central Hemodynamics

 Jaewon Oh  ;  Chan Joo Lee  ;  In‐Cheol Kim  ;  Sang‐Hak Lee  ;  Seok‐Min Kang  ;  Donghoon Choi  ;  Sungha Park  ;  Kazuomi Kario 
 Journal of the American Heart Association, Vol.6(2) : 005424, 2017 
Journal Title
 Journal of the American Heart Association 
Issue Date
Blood Pressure Monitoring, Ambulatory ; Circadian Rhythm/physiology* ; Female ; Hemodynamics/physiology* ; Humans ; Hypertension/diagnosis ; Hypertension/epidemiology ; Hypertension/physiopathology* ; Male ; Middle Aged ; Morbidity/trends ; Prognosis ; Republic of Korea/epidemiology ; Risk Assessment/methods* ; Risk Factors
ambulatory blood pressure monitoring ; arterial stiffness ; hypertension ; morning hypertension ; nocturnal hypertension
BACKGROUND: A recent study reported that morning hypertension is associated with poor cardiovascular outcomes in hypertensive patients. However, it is unclear whether morning hypertension associated with sustained nocturnal hypertension and that associated with morning blood pressure (BP) surge differ in terms of their effects on cardiovascular target organ damage and clinical outcomes. The present study aimed to determine the association of morning hypertension with/without nocturnal hypertension with vascular target organ damage and central hemodynamics in patients at high risk for cardiovascular disease. METHODS AND RESULTS: Ambulatory BP monitoring was performed and central BP was measured in 1070 consecutive patients with high cardiovascular risk. We grouped morning hypertension into the following 3 subtypes: (I) morning normotension; (II) morning hypertension without nocturnal hypertension; and (III) morning hypertension with nocturnal hypertension. Morning hypertension was noted in 469 (43.8%) patients and morning hypertension with nocturnal hypertension was noted in 374 (34.9%) patients. The central systolic/diastolic BP and carotid to femoral pulse wave velocity were significantly higher in the subtype III group than in the subtype I and II groups (all P<0.001). Subtype III (versus subtype I) was an independent predictor of central hypertension and high-risk arterial stiffness (P<0.001 and P=0.018, respectively) but not vascular damage in a fully adjusted model (model Y). CONCLUSIONS: Morning hypertension, especially that associated with nocturnal hypertension, is related to high central BP and increased arterial stiffness. Further studies on whether morning hypertension with or without nocturnal hypertension is related to clinical outcomes should be performed. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02003781.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
강석민(Kang, Seok Min) ORCID logo https://orcid.org/0000-0001-9856-9227
김인철(Kim, In Cheol)
박성하(Park, Sung Ha) ORCID logo https://orcid.org/0000-0001-5362-478X
오재원(Oh, Jae Won) ORCID logo https://orcid.org/0000-0002-4585-1488
이상학(Lee, Sang Hak) ORCID logo https://orcid.org/0000-0002-4535-3745
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
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