Morning hypertension: A pitfall of current hypertensive management

Morning hypertension has recently attracted more attention because of the close relation between blood pressure levels in the early morning and cardiovascular risk. Cases of morning hypertension, i.e., higher blood pressure in the early morning than in the evening, are classified into two types: the "morning-surge" type, characterized by a marked increase in blood pressure in the early morning, and the "nocturnal-hypertension" type, characterized by high blood pressure that persists from nighttime until early morning. Although these two types are caused by different pathologic mechanisms, both result in hypertensive organ damage and increase cardiovascular risk. Control of morning hypertension can be regarded as the gateway to strict 24-hour blood pressure control. Standard antihypertensive treatment in accord with current guidelines, when combined with chronobiologic antihypertensive treatment focused on morning hypertension and guided by home blood pressure monitoring, seems to provide more effective prevention of cardiovascular events.