Document Detail


Cardiovascular risk and therapeutic intervention for the early morning surge in blood pressure and heart rate.
MedLine Citation:
PMID:  11433126     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The incidence of most adverse cardiovascular events appears to follow a circadian pattern, reaching a peak in the morning shortly after wakening and arising. The activities of many physiologic parameters, including hemodynamic, hematologic and humoral factors, also fluctuate in a cyclical manner over the 24h. It has been suggested that, during the post-awakening hours, the phases of these cycles synchronize to create an environment that predisposes to atherosclerotic plaque rupture and thrombosis in susceptible individuals, thereby accounting for the heightened cardiovascular risk at this time of day. Blood pressure and heart rate are part of this physiologic process, following a clear circadian rhythm characterized by a fall during sleep and a sharp rise upon awakening. This so-called 'morning surge' in blood pressure may act as a trigger for cardiovascular events, including myocardial infarction and stroke. The clinical implication of these observations is that antihypertensive therapy should provide blood pressure control over the entire interval between doses. For agents taken once daily in the morning, the time of trough plasma drug level (and lowest pharmacodynamic effect) will often coincide with the early morning surge in blood pressure and heart rate. For these reasons, chronotherapeutic formulations of drugs and intrinsically long-acting antihypertensive agents provide the most logical approach to the treatment of hypertensive patients since they provide 24 h blood pressure control from a single daily dose as well as attenuating the early morning rise in blood pressure (and in some instances heart rate).
Authors:
W B White
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Blood pressure monitoring     Volume:  6     ISSN:  1359-5237     ISO Abbreviation:  Blood Press Monit     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-07-02     Completed Date:  2002-01-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9606438     Medline TA:  Blood Press Monit     Country:  England    
Other Details:
Languages:  eng     Pagination:  63-72     Citation Subset:  IM    
Affiliation:
Section of Hypertension and Clinical Pharmacology, University of Connecticut School of Medicine, Farmington, Connecticut 06030-3940, USA. wwhite@nso1.uchc.edu
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure / physiology*
Cardiovascular Diseases / diagnosis,  physiopathology*,  therapy
Circadian Rhythm / physiology*
Female
Heart Rate / physiology*
Humans
Male
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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