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Heart attacks and strokes occur more commonly in the morning hours. The reason for this is unknown but some researchers have suggested that the increased risk of heart attack and stroke may be caused by a much greater than normal rise in blood pressure just after waking – ‘An exaggerated morning blood pressure surge’.

Defining the prognostic value of the morning blood pressure surge in clinical practice

Patients with an exaggerated morning blood pressure surge can be identified by monitoring blood pressure for 24 hours and studying how the blood pressure level changes when the patient wakes up. This type of blood pressure monitoring is becoming increasingly common in routine clinical practice and was recently recommended in the UK for the routine diagnosis of high blood pressure (hypertension). However, there is still some debate about what level of morning blood pressure surge should be considered for treatment and some who think that an exaggerated morning blood pressure surge is not a predictor of risk at all.

Dr James Sheppard and researchers at the Universities of Oxford and Birmingham completed a School for Primary Care Research funded comprehensive review of the literature to establish the most appropriate definition of morning blood pressure surge which could be used by doctors to guide treatment in routine clinical practice. "We identified 17 research studies examining the link between the morning blood pressure surge and heart attack or stroke. These studies found a total of 7 different definitions of morning blood pressure surge, but there was no evidence that a specific level of morning blood pressure surge (by any definition) was associated with an increased risk of heart attack or stroke. There was some evidence that an increasing morning blood pressure surge is associated with an increased stroke risk, but, due to the limited number of studies showing this association this finding needs further investigation." The findings of the systematic review are published in the American Journal of Hypertension.

There is still some debate about what level of morning blood pressure surge should be considered for treatment and some who think that an exaggerated morning blood pressure surge is not a predictor of risk at all."
- Dr James Sheppard

The research team now intend to examine this association further in future work re-assessing individual patient data from previous studies in a follow-up review. Should this confirm that an increasing morning blood pressure surge is associated with an increased risk of heart attack and stroke more work will be required to establish an appropriate treatment regime, which will reduce a patient’s risk of heart attack and stroke in the morning hours.