Morning blood pressure

Blood pressure (BP) follows a daily pattern. It is normally lower at night while you are sleeping and starts to rise a few hours before you wake up. This rise in BP continues during the day, usually peaking in the middle of the afternoon. By late afternoon or evening, your BP would begin to drop again.

Some people experience abnormality in their BP pattern. One of it is a morning surge in BP (also known as morning hypertension), which results in increased risk of damage to the brain, heart and kidneys. Morning hypertension could also happen in those with well-controlled BP.

Morning hypertension can be defined based on blood pressure (BP) readings in the early morning and at bedtime. You may have morning hypertension if:

The two types of morning hypertension²

When you first wake up in the morning, blood pressure (BP) increases due to the body’s normal circadian rhythm. Circadian rhythm is a daily 24-hour activity cycle that affects our sleep/wake patterns. In the morning, the body releases certain hormones such as adrenaline and noradrenaline. These hormones give you energy boosts but can also raise your BP. This morning increase in BP is usually seen between 6 am and noon. Harmful effects can be seen if the BP rises too high.

The following factors may put you at risk for morning hypertension:

Those with morning hypertension have a higher risk for heart attack, stroke and sudden death in the first few hours of the morning compared with those without morning hypertension.

If you experience symptoms such as severe headache, chest pain, and numbness or tingling in your face or arms, be sure to contact your doctor immediately.

Having a home blood pressure (BP) monitor at hand can be useful in determining whether you have morning hypertension. These devices are easily available at your neighbourhood pharmacy, and are reasonably priced. There are several types of monitors available, so talk to your pharmacist about the type of model that would suit you best.

It is best to check your BP, using the same arm each time, at the following times:

Morning hypertension generally happens because the effects of the antihypertensive medications a person is on do not last for 24 hours. Hence, your doctor may recommend antihypertensive medications that target morning hypertension to be combined with your existing hypertension treatment.

Before this additional medication is prescribed, the first step of treatment is self-monitoring of early morning blood pressure (BP) at home. Once you have been diagnosed with morning hypertension, your doctor will adjust your medications to reduce the surge in morning BP.

In order to prevent the development of morning hypertension or to keep it under control, you should practice the following:

• Eat a nutritious diet
• Avoid tobacco and alcohol
• Engage in regular physical activity
• Take blood pressure (BP) medications as prescribed
• Keep a log of BP readings