In China, the prevalence of hypertension is on the rise. Some hypertensive patients experience dizziness in the morning or at noon, often attributing these symptoms to fatigue and believing they can be alleviated with rest, thus failing to recognize their significance. In reality, this is frequently attributable to elevated morning blood pressure.

Research indicates that the period between 7:00 AM and 10:00 AM is a peak window for cardiovascular events. Stabilizing blood pressure control and avoiding the morning surge are particularly crucial for reducing cardiovascular risk.

What is Morning Blood Pressure?

Morning blood pressure is defined as:

• Home self-measured blood pressure readings taken within 1 hour of waking, before medication intake, and before breakfast.
• Blood pressure recorded by ambulatory blood pressure monitoring within 2 hours of rising or during the 6:00 AM to 10:00 AM period.

Narrow Definition:

Blood pressure is elevated *only* during the morning period while remaining within normal ranges at other times of the day. This condition represents a form of masked hypertension.

Broad Definition:

This refers to an average home blood pressure reading of ≥135/85 mmHg or an average office blood pressure reading of ≥140/90 mmHg, *regardless* of whether blood pressure at other times is above normal levels.

The Hazards of Elevated Morning Blood Pressure

In hypertensive patients, blood pressure fluctuates continuously throughout the day. During the morning hours, as the body transitions from sleep to wakefulness, blood pressure exhibits a significant rising trend. If this increase in blood pressure is excessive, it can cause varying degrees of damage to target organs such as the heart, brain, and kidneys, and may even trigger severe events like myocardial infarction (heart attack) and stroke.

Furthermore, epidemiological studies indicate that the morning period carries a higher probability of adverse cardiovascular events—including myocardial infarction (MI), sudden cardiac death (SCD), and ischemic stroke—compared to other times during the day and night [1].

• Diurnal/Nocturnal Pattern of Adverse Cardiovascular Events

Some hypertensive patients neglect the management of their morning blood pressure, thereby increasing the risk of triggering adverse cardiovascular events. Therefore, it is crucial to scientifically manage and prioritize morning blood pressure to prevent such occurrences.

Morning Blood Pressure: Monitoring and Treatment Principles

Home Blood Pressure Monitoring:

Key recommendations for home blood pressure measurement include:

• Measurement should be performed within 30 minutes to 1 hour after waking, typically between 6:00 AM and 10:00 AM.
• It should ideally be conducted before taking medication and before breakfast.
• Prior to measurement, the bladder should be emptied, and the individual should be seated whenever possible.

Principles for Treating Morning Hypertension:

• Utilize antihypertensive medications with a half-life of 24 hours or longer. Truly long-acting agents suitable for once-daily dosing that effectively control blood pressure over 24 hours are recommended to avoid iatrogenic poor morning blood pressure control due to inappropriate treatment selection.
• Employ safe medications that are suitable for long-term use and provide effective 24-hour blood pressure control, thereby enhancing patient treatment adherence.
• For patients with isolated morning hypertension, adjusting the timing of medication administration may also be considered.
• Select medications supported by substantial clinical trial evidence demonstrating cardiovascular and cerebrovascular benefits, and proven to genuinely reduce long-term cardiovascular and cerebrobrovascular events, thereby improving the quality of life for hypertensive patients.

Morning Blood Pressure Management Protocol

Morning blood pressure is closely associated with cardiovascular and cerebrovascular diseases.Therefore, effective management of morning blood pressure is of paramount importance for reducing the risk of such events. By working closely with healthcare providers to maintain rigorous monitoring and active treatment—and by selecting long-acting antihypertensive agents that provide genuine 24-hour blood pressure control—patients can minimize the risks associated with hypertension.