- High blood pressure
- Morning blood pressure
Daily blood pressure pattern
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.
What is morning hypertension?
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
What causes morning hypertension?
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.
What are the consequences of 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.
How do I know if I have morning hypertension?
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:
How is morning hypertension treated?
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.
How can I prevent or control morning hypertension?
- Mayo Clinic. High blood pressure (Hypertension). Available at http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/blood-pressure/faq-20058115. Accessed 19 September, 2019.
- Kario K.JMAJ 2005; 48(5):234-240.
- Pharmacy Times. Early to rise? Your blood pressure may be too. Available at https://www.pharmacytimes.com/publications/issue/2007/2007-04/2007-04-6392. Accessed 8 October, 2019.
- Kaplan NM. Circulation 2003;107:1347.
- British Hypertension Society. Home blood pressure monitoring protocol. Available at https://bihsoc.org/wp-content/uploads/2017/09/Protocol.pdf. Accessed 8 October, 2019.