Vol. 46 | No. 2 | July-December 2018 Back

Open Access

Blood Pressure Morning Surge in Hypertensive Filipino Patients: A 24-Hour Ambulatory Blood Pressure Monitoring Study in a Tertiary Hospital

Jason S. Santos, Raymund A. Naranjilla
Dec 2018 DOI 10.69944/pjc.72412c5102

Abstract

BACKGROUND: The prevalence of hypertension is increasing in the Philippines. Hypertension is often associated  with an exaggerated increase in blood pressure (BP) in the morning, referred to as morning surge – a phenomenon known to increase the risk of cardiovascular events. This study aims to determine whether morning surge is present in hypertensive Filipino patients and whether this correlates with control of hypertension. 

Methods: This was a retrospective study that included 134 hypertensive patients who underwent 24-hour  ambulatory BP monitoring at the University of Santo Tomas Hospital from January to December 2016. The BP morning surge was defined as >20 mmHg difference between the BP two hours before and two hours after awakening. The prevalence was reported and analyzed by age, sex and hypertension control. 

Results: The prevalence rate of BP morning surge (i.e., score >20 mmHg) was 36.6%. Patients with surge score >20 mmHg were older compared to those with lower surge scores (46.98  ± 14.45 vs 51.55 ± 13.89 years; p=0.031). The prevalence rate was significantly increased in male patients (65.3%) compared to female patients (34.69%; p=0.003). There was no significant correlation between the control of BP and the presence of morning surge (p=0.210). Multivariate analysis confirmed that sex was the risk factor most correlated with morning surge, with male patients having 2.7 times the risk of having a morning surge score >20 mmHg compared with female patients. 

Conclusion: Morning surge was present in 36.6% of hypertensive Filipino patients who underwent 24-hour  ABPM at the University of Santo Tomas Hospital over a one-year period. Male sex was correlated with the presence of morning surge while control of hypertension showed no correlation. The latter could be due to a blunting of the morning surge by higher trough BP in patients with uncontrolled hypertension. 

KEYWORDS: systemic arterial hypertension, 24-hour ambulatory blood pressure monitoring, blood pressure, morning  surge, surge score.

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