Professor Liu of the University of hypertension for more than 10 years, think in this area of blood pressure management is very knowledgeable: take medication on time, adhere to the daily self-measurement of blood pressure, appropriate exercise. In the past few years after retirement, he also insisted on playing Taijiquan every morning for fitness. However, one morning a few days ago, Professor Liu suddenly fainted during his morning exercise and was diagnosed with cerebral hemorrhage at the hospital, his life was saved, but the sequelae still seriously affected his quality of life. The family members were baffled as to how the old man, whose blood pressure had always been well controlled, suddenly developed an attack. The family was puzzled as to how the sudden onset of the disease could have happened to the old man whose blood pressure was always well controlled.
In fact, this is the trouble of early morning hypertension.
Hypertension is a common chronic disease and the most important risk factor for cardiovascular and cerebrovascular diseases. Among all types of hypertension, early morning hypertension is often overlooked, but its harm is not small. Many people with hypertension believe that taking one blood pressure measurement during the day every day is sufficient, but it is not.
A single measurement during the day often does not reflect the true blood pressure level and does not reveal the signs of early morning hypertension. Therefore, many hypertensive patients think that their blood pressure is well controlled, but they do not know that the “volcano” of hypertension is hidden around them in the early morning and will “erupt” if they are not careful.
What is early morning hypertension?
Early morning blood pressure can be defined as any of the following.
A home blood pressure measurement taken within 1 hour of waking up, before taking medication, or before breakfast;
Ambulatory blood pressure recorded 2 hours after waking up;
Blood pressure between 6:00 am and 10:00 am.
Early morning hypertension is defined as a home blood pressure ≥135/85 mmHg and/or office blood pressure ≥140 mmHg.
Why does early morning hypertension occur?
Early morning hypertension results from the diurnal pattern of blood pressure. Controlled by the body’s biological clock, blood pressure is constantly changing within 24 hours.
The blood pressure is constantly changing within 24 hours. Even for people with normal blood pressure, the blood pressure level also shows a more obvious circadian rhythm, which can be simply summarized as “two peaks and a valley”. Early in the morning, after waking up, blood pressure rises significantly from 8:00 to 10:00, showing a peak, and then falls;
In the afternoon, between 17:00 and 18:00, blood pressure rises again from a trough to a peak;
At night, from 2:00 to 3:00, blood pressure is at its lowest, with another trough, and so on.
Under physiological conditions, the systolic and diastolic blood pressure at awakening will usually increase by 10% to 20% compared to sleep, if the rise is too large, it is a pathological state, harmful to the human body, we should pay attention to.
Third, the danger of early morning hypertension
Early morning hypertension can produce serious damage to the heart, brain, kidneys and blood vessels. Early morning hypertension is the primary risk factor for the high incidence of cardiovascular events, and it is more important to control early morning blood pressure in Asian populations. Epidemiological surveys show that approximately 40% of myocardial infarctions and 29% of sudden cardiac deaths occur in the early morning hours. Early morning hypertension is also the strongest independent risk factor for stroke, with the incidence of stroke three to four times higher than at other times of the day. Therefore, it is especially important for stroke patients or those at high risk of stroke to keep their blood pressure under control in the early morning.
In addition, the relative risk of carotid atherosclerosis is increased 5-fold in patients with early morning hypertension. It may also aggravate kidney function damage in patients with chronic kidney disease. However, about 60% of our
of patients with controlled blood pressure in the clinic do not have well-controlled early morning blood pressure, which is basically a blind spot for blood pressure management. Therefore, it is imperative to recognize and manage early morning hypertension.
IV. How to manage
Generally speaking, the occurrence of early morning hypertension is not only related to one’s own pathophysiology, high sodium intake, smoking, alcohol, diabetes and other risk factors, but also due to poor blood pressure management.
Early morning blood pressure standard means 24-hour blood pressure standard, and early morning blood pressure is a better predictor of stroke risk than nighttime blood pressure.
Therefore, it is particularly important to manage early morning blood pressure well. We can do this in a number of ways.
1. Measure blood pressure correctly
The methods of monitoring include home blood pressure monitoring, 24-hour ambulatory blood pressure monitoring, and in-office blood pressure monitoring. When conditions allow, two or three methods can be used in combination to more accurately grasp the blood pressure management situation.
The scientific way to measure blood pressure should be within one hour after waking up, usually between 6:00 and 10:00.
The blood pressure should be measured within 1 hour of waking up, usually between 6:00 and 10:00 a.m.; before taking medication and before breakfast, if possible; and before taking a blood pressure test by emptying the bladder and taking a sitting position, if possible.
For elderly patients with hypertension, in order to prevent postural hypotension, in addition to monitoring the sitting early morning blood pressure, also measure the blood pressure while standing or lying down.
2. Daily blood pressure management in patients with early morning hypertension
As with the general treatment of hypertension, three “restrictions” and four “insistences” should be emphasized when dealing with early morning hypertension: limiting exercise intensity, limiting salt (less than 6
We should limit the intensity of exercise, salt (less than 6 grams per day) and fat intake, smoking and alcohol consumption; adhere to regular medication, blood pressure measurement, regular follow-up, and a good state of mind and adequate sleep.
V. But the treatment of early morning hypertension also has its special characteristics.
1.Drug taking
Reasonable and standardized use of antihypertensive drugs is the key to effective management of early morning blood pressure, and the best blood pressure control program should be to ensure that the antihypertensive efficacy covers the entire 24 hours.
If early morning hypertension is still poorly controlled after taking medication, it can be switched to a long-acting antihypertensive drug once a day under the guidance of a physician.
The timing of the medication can also be adjusted according to the early morning and nighttime blood pressure under the guidance of the physician for better control of early morning blood pressure.
Combine medications or use compounded preparations if necessary.
2.Morning exercise
Patients with early morning hypertension have an increased risk of cardiovascular events after early morning exercise compared to other times of the day compared to healthy people or people with hypertension in general. Therefore, in 6:00 to 10:00 to avoid strenuous activities, it is recommended to schedule the exercise in the afternoon or evening, will be safer.
For patients who must insist on morning exercise, short-acting antihypertensive drugs, such as nifedipine, can be taken after rising in the morning under the guidance of physicians to improve the safety of morning exercise.
The elderly should pay special attention to the fact that they should not get up immediately after waking up in the morning, and their activities should not be too strong after getting up, and they should gradually transition from small amounts to daily work life.
3. Three knowings
Knowing that controlling high blood pressure in the early morning is crucial to effectively reduce cardiovascular events;
Know to insist on measuring home blood pressure in the early morning before taking medication, and record it accurately and bring it to the doctor during the follow-up consultation;
Know to insist on taking long-acting antihypertensive drugs early in the morning and instruct patients on the correct way to measure early morning blood pressure at home.
The day’s plan is to spend the day happily and smoothly, which should start with paying attention to blood pressure in the early morning.
In conclusion,
For patients with hypertension, especially elderly patients with hypertension, they should choose and adhere to adequate doses of long-acting antihypertensive medications while developing proper early morning blood pressure monitoring habits, and also pay attention to lifestyle, diet structure, and exercise habit adjustment. Only with a combination of blood pressure management can the volcano of early morning hypertension not erupt easily.