THE ASSOCIATIONS OF TARGET ORGAN DAMAGE WITH MORNING HYPERTENSION BY VARIOUS DEFINITIONS

Objective: Morning Hypertension (MHT) can be defined based on ambulatory blood pressure (BP) monitoring (ABPM) or home BP monitoring (HBPM). In which definition MHT is more associated with cardiovascular outcome remains unknown. Design and method: From 2010–2015, we consecutively recruited untreated outpatients from our Hypertension Clinic. MHT was an average BP of at least 135/85 mmHg in the morning defined either based on HBPM, or the diary (the first 2 h after awakening) or short-clock time interval (6–10 AM) on the day of ABPM, irrespective of the BP levels at other time windows. We assessed carotid-femoral pulse wave velocity (cfPWV) by SphygmoCor system, left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) by ultrasonography, and urinary albumin/creatinine ratio (ACR) as measures of target organ damage. Results: In the 1085 untreated patients (age 51.2 years), the prevalence of MHT were 63.7%, 65.1% and 48.7% based on the ABPM diary, short-clock time interval and HBPM, respectively. After adjustment for age, sex, and other cardiovascular risk factors, patients with MHT compared to normotensives had significantly (P < 0.001) increased cfPWV, urinary ACR and carotid IMT, irrespective of the definitions. In multivariate-adjusted continuous analyses, target organ measures were all positively associated with morning systolic BP recorded by ABPM and HBPM (P < 0.002), except for that of LVMI with home BP. After further including the systolic BP at other time windows in the models, morning systolic BP during 6–10 AM remained significantly associated with cfPWV (β = 0.019, P < 0.001), and home morning systolic BP was associated with cfPWV (β = 0.024, P < 0.001) and urinary ACR (β = 0.012, P = 0.003). Conclusions: Irrespective of the definitions based on ABPM or HBPM, morning hypertension was associated with target organ measures.