Early morning is the most blessed time of the day, but in the minds of cardiovascular doctors, early morning is considered the “devil’s time”. How scary is early morning hypertension? Studies have shown that early morning is a high incidence of cardiovascular events, with the peak incidence of sudden death, myocardial infarction and stroke occurring within 4 to 6 hours before and after awakening. The risk of ischemic stroke is four times higher in the early morning hours; the risk of cardiovascular death increases by 70% between 7 and 9 am compared to other times of the day. The occurrence of all these events is strongly associated with elevated blood pressure in the early morning. As the body shifts from sleep to wakefulness, blood pressure tends to rise significantly, and the highest blood pressure of the day is in the early morning hours. With the advent of ambulatory blood pressure monitoring, it has been found that human blood pressure decreases significantly in the hours after sleep and increases significantly in the early morning hours before and after awakening. Under physiological conditions, the rise in blood pressure before and after awakening usually does not exceed 15 mmHg. In hypertensive people, the rise in blood pressure during the early morning hours can be ≥25 mmHg, and this phenomenon is clinically described by early morning blood pressure. How is early morning hypertension classified? Early morning hypertension can be classified into narrow sense and broad sense. Narrow sense means that blood pressure is higher than normal only in the early morning hours, but normal in other hours; broad sense means that blood pressure is higher than normal not only in the early morning hours, but also in other hours. In the broader sense, early morning hypertension is more closely related to target organ damage and cardiovascular and cerebrovascular events. Factors influencing early morning hypertension Prolonged high blood pressure in the early morning may be associated with increased sympathetic nervous system activity around early morning, over-activation of the renin-angiotensin-aldosterone system, excessive release of catecholamines, and simultaneous peak plasma cortisol secretion in the early morning. It is also influenced by the patient’s age, sodium intake, smoking, alcohol consumption, diabetes, abnormal fasting glucose, metabolic syndrome, and mental anxiety. There are ways to assess early morning blood pressure Studies have shown that elevated blood pressure during the early morning hours can lead to cerebrovascular pathology, abnormal coagulation and renal changes, as well as microvascular and macrovascular abnormalities, which can cause a higher incidence of cardiovascular events. Therefore, China issued the “Early Morning Blood Pressure Clinical Management Chinese Expert Guidance Recommendations”, which clearly recommends early morning blood pressure as an indicator for assessing blood pressure in the early morning hours. There are three ways to assess early morning blood pressure: 1) patients go to the hospital between 6 and 10 am to measure it, 2) they measure it with a home blood pressure meter within one hour after waking up, and 3) they wear a 24-hour ambulatory blood pressure monitor to observe the changes in blood pressure in the early morning. All three methods allow patients to understand the indicators of early morning blood pressure monitoring, with home self-measurement being the most convenient to achieve. The scientific home measurement of early morning blood pressure is the result of home blood pressure measurement within 0.5-1.0 h after waking up, before taking medication, before breakfast, and in a sitting position after urination. Early morning hypertension is defined as early morning blood pressure when home blood pressure monitoring or ambulatory blood pressure monitoring is ≥135/85 mm Hg and/or office blood pressure is ≥140/90 mm Hg. The blood pressure control of our hypertensive patients is still not optimistic, and early morning blood pressure management is an effective leverage point, so we should work together to go for effective control of early morning hypertension.