Clinical Research On Morning Hypertension

Objective:There is a close relationship between cerebro-cardiovascular risk and morning hypertension,a hypertension subtype which deserves more research.However,the prevalence,determinants,the best assessment method,and metabolic molecular mechanisms of morning hypertension were still unclear.Methods:Firstly,we used the database of the China Ambulatory and Home Blood Pressure Registry(ABPR)and explored the prevalence and determinants of morning hypertension by different definitions.Morning hypertension was defined as an elevated morning blood pressure of at least 135/85 mmHg recorded by 24-h ambulatory blood pressure monitoring(ABPM)during the first 2h after awakening or during 6-10 AM or self-measured at home.Second,in untreated outpatients recruited from the Hypertension Department,Ruijin Hospital,we used both the ABPM and home blood pressure monitoring(HBPM)to assess morning blood pressure,and explored the reproducibility of morning blood pressure and its association with arterial measures,including carotid-femoral pulse wave velocity(cfPWV),carotid intima-media thickness and urinary albumin/creatinine ratio(ACR).In Shanghai and Malmo elderly community dwellings,we compared risk profiles associated with cfPWV.Finally,we examined metabolic profile of 180 serum samples obtained from untreated outpatients with Isolated morning hypertension,normotension controls and sustained hypertension controls by the liquid chromatography-mass spectrometry to explore the metabolites and pathways likely associated with morning hypertension.Cases and controls were matched for age,sex,fasting glucose and serum total cholesterol.Results:In 3197 subjects registered from the ABPR study,the prevalence of morning hypertension defined by home morning blood pressure and ambulatory blood pressure recorded during the first 2h after awakening or during 6:00-10:00 AM were 52.1%,55.7%and 54.0%,respectively.Irrespective of the definitions,determinants associated with morning hypertension were similar.In 1049 untreated outpatients,morning blood pressures were all significantly(P?0.03)associated with arterial measures,irrespective of the assessment methods.However,morning blood pressure assessed by HBPM showed better reproducibility and stronger correlation with cfPWV and urinary ACR(P<0.001).The prevalence of isolated morning hypertension is about 10%,and the associated target organ damage was mainly characterized as a faster cfPWV(P?0.002).In Shanghai and Malmo elderly subjects,cfPWV had similar determinants,while the standardized effect size associated with age and fasting plasma glucose was greater in the Swedish than Chinese subjects,and those with body mass index,mean arterial pressure,and heart rate were greater in Chinese.Compared to normotensive subjects,patients with isolated morning hypertension and sustained hypertension showed metabolic disturbance in the glycerophospholipid and sphingolipid pathways.Conclusions:Morning hypertension is prevalent in Chinese.HBPM assessed morning blood pressure showed better reproducibility and closer association with arterial measures.Patients in different populations shared similar major risk factors of arterial stiffness,but with some differences in the strength of associations.Morning hypertension may be associated with the disturbed phospholipids pathways.