Sudden Rise In Awakening Blood Pressure

Released: 22-May-1997 12:00 AM EDT
Source Newsroom: American Society of Hypertension (ASH)
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For More Information:
Bob Schwadron; 212-468-3616; RSchwadr@DMBB.com

SUDDEN RISE IN AWAKENING BLOOD PRESSURE LINKED TO SERIOUS HEART DAMAGE

NEW YORK, NY -- Linkage between a sudden rise in blood
pressure upon awakening and potentially dangerous enlargement of the
heart's main pumping chamber is established in a study in the May issue
of the American Journal of Hypertension.

Results of the ten year study of 181 patients showed a strong
statistical relationship between early morning blood pressure readings
and the size of the left ventricle, the part of the heart that pumps blood to
most of the critical parts of the body. Enlargement of the left ventricle is
often associated with serious cardiovascular events, such as heart
attack, stroke or sudden death.

"The findings in the May issue by Gosse and colleagues clearly
document a significant statistical relationship between early morning
blood pressure and the size of the left ventricle," says Michael Weber,
MD, an editor of the American Journal of Hypertension, the
peer-reviewed journal of the American Society of Hypertension.

"The results indicate that those patients with the highest
awakening blood pressures had the greatest evidence for enlargement
of the heart," he continued. "These findings might help physicians by
identifying those patients at greatest risk, becoming more aggressive in
treating those patients and using medications for treating high blood
pressure that have their strongest actions during the critical morning
hours."

Nearly 50 million Americans have high blood pressure, called the
silent killer because it prematurely ages the body's arteries and can lead
to strokes, heart attacks and kidney failure, often without warning.

Gosse and colleagues from the Hospital Saint Andre in Bordeaux,
France, followed 181 hypertensive patients (128 men and 53 women)
who had been previously untreated from 1986 to 1996. Blood pressure
of the patients was measured three times in the physician's office and
then echocardiography was performed to measure the weight and wall
thickness of the left ventricle.

Patients were fitted with ambulatory blood pressure monitoring
devices to automatically record blood pressure throughout the day and
were instructed to trigger their device immediately upon awakening and
standing.

"This simple method, in which the patient was also requested to
trigger a measurement immediately after getting into bed, produced an
accurate indication of the time of arising in the morning and retiring at
night," Gosse and colleagues reported. "We had previously found that
these times were not always accurately recorded in the patients'
diaries."

Almost all people experience a rise in blood pressure and heart
rate when they wake up, the authors note. However, in their study, "Left
Ventricular Mass Is Better Correlated With Arising Blood Pressure Than
With Office or Occasional Blood Pressure," Gosse and colleagues report
that blood pressure of patients with enlarged left ventricles had
wakening blood pressure elevations that were strikingly higher -- an
average 19 mm Hg systolic and 16 mm Hg diastolic.

"We found a highly significant correlation between blood
pressure measured immediately after arising in the morning and left
ventricular mass in untreated hypertensive patients," the researchers
said. "This correlation with a single measurement on getting up was
significantly higher than that between left ventricular mass and office
blood pressure (mean of three measurements)."

According to Dr. Weber, the findings "will provoke further studies
of the importance of the early morning blood pressure and especially will
encourage physicians to measure blood pressure more closely at this
time. One way to achieve this is to instruct patients to check their blood
pressures at home, especially as soon as they awaken in the morning."

The American Society of Hypertension is the largest US
organization devoted exclusively to hypertension and related
cardiovascular diseases. The organization is committed to alerting
physicians, allied health professionals and the public about new medical
options, facts, research findings and treatment choices designed to
reduce the risk of cardiovascular disease.

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