Morning surge in blood pressure and blood pressure variability in Asia: Evidence and statement from the HOPE Asia Network

HOPE Asia Network

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Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. To effectively prevent end-organ damage, maintain vascular integrity and reduce morbidity and mortality, it is essential to decrease and adequately control blood pressure (BP) throughout each 24-hour period. Exaggerated early morning BP surge (EMBS) is one component of BP variability (BPV), and has been associated with an increased risk of stroke and cardiovascular events, independently of 24-hour average BP. BPV includes circadian, short-term and long-term components, and can best be documented using out-of-office techniques such as ambulatory and/or home BP monitoring. There is a large body of evidence linking both BPV and EMBS with increased rates of adverse cardio- and cerebrovascular events, and end-organ damage. Differences in hypertension and related cardiovascular disease rates have been reported between Western and Asian populations, including a higher rate of stroke, higher prevalence of metabolic syndrome, greater salt sensitivity and more common high morning and nocturnal BP readings in Asians. This highlights a need for BP management strategies that take into account ethnic differences. In general, long-acting antihypertensives that control BP throughout the 24-hour period are preferred; amlodipine and telmisartan have been shown to control EMBS more effectively than valsartan. Home and ambulatory BP monitoring should form an essential part of hypertension management, with individualized pharmacotherapy to achieve optimal 24-hour BP control particularly the EMBS and provide the best cardio- and cerebrovascular protection. Future research should facilitate better understanding of BPV, allowing optimization of strategies for the detection and treatment of hypertension to reduce adverse outcomes.

Original languageEnglish
Pages (from-to)324-334
Number of pages11
JournalJournal of Clinical Hypertension
Issue number2
Publication statusPublished - 2019 Feb

Bibliographical note

Funding Information:
K Kario received research grant from Teijin Pharma Limited; Omron Healthcare Co., Ltd.; Fukuda Denshi Co., Ltd.; Bayer Yakuhin Ltd.; A &D Co., Ltd.; Daiichi Sankyo Company, Limited; Mochida Pharmaceutical Co., Ltd.; EA pharma; Boehringer Ingelheim Japan Inc; Tanabe Mitsubishi Pharma Corporation; Shionogi & Co., Ltd.; MSD KK; Sanwa Kagaku Kenkyusho Co., Ltd.; Bristol‐Myers Squibb KK; Pfizer Japan Inc; Otsuka Holdings Co., Ltd. and honoraria from Takeda Pharmaceutical Co., Ltd.; Daiichi Sankyo Co., Ltd.; Omron Healthcare Co., Ltd.; Terumo Corporation. S Park has received re‐ search grants and honoraria from Pfizer. S Siddique has received honoraria from Bayer, GlaxoSmithKline, Pfizer, ICI, Novartis and Servier; and travel, accommodation and conference registration support from Atco Pharmaceutical, Werrick Pharma, Highnoon Laboratories, Horizon Pharma, ICI, OBS and Pfizer. YC Chia has received speaker honoraria and sponsorship to attend conferences and CME seminars from Abbott, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Menarini, Merck Sharp & Dohme, Novartis, Orient Europharma, Pfizer, and Sanofi; and a research grant from Pfizer. CH Chen has received honoraria as a member of a speaker’s bureau for Pfizer. R Divinagracia has received honoraria as a mem‐ ber of speakers’ bureaus for Bayer, Novartis, and Pfizer. J Sison has received honoraria from Pfizer, AstraZeneca, Boehringer Ingelheim and Novartis. GP Sogunuru has received a research grant related to hypertension monitoring and treatment from Pfizer. JC Tay has received advisory board and consultant honoraria from Pfizer. JG Wang has received research grants from Bayer, Pfizer, and Phillips; and lecture and consulting fees from Bayer, Daiichi‐Sankyo, Merck Sharp & Dohme, Pfizer, Sanofi, and Servier. L Wong has received honoraria from Bristol‐Myers Squibb and Pfizer. Y Zhang has re‐ ceived research grants from Bayer, Novartis, and Shuanghe; and lecture fees from Bayer, Daiichi Sankyo, Novartis, Pfizer, Sanofi, Servier, and Takeda. All other authors report no potential conflicts of interest in relation to this article.

Publisher Copyright:
©2018 Wiley Periodicals, Inc.

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine


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