Importance of aggressive blood pressure lowering when it may matter most.

Variation in blood pressure levels follows a reproducible circadian pattern, characterized by low levels during sleep and a rapid increase during the early-morning period. The incidence of cardiovascular events displays a similar circadian variation, with peak occurrence coinciding with the early-morning blood pressure surge. Numerous prospective studies have shown that blood pressure measured over a 24-hour period is superior to clinic blood pressure in predicting future cardiovascular events. Thus, the use of ambulatory blood pressure monitoring (ABPM) to identify patients at risk of cardiovascular events could improve the management of the patient with hypertension. ABPM has also become widely adopted to evaluate antihypertensive therapeutic options that might provide blood pressure reduction throughout the 24-hour dosing interval. Recently, community-based trials have shown that it is feasible to perform ABPM-oriented research in nonresearch environments. This allows us to better understand the efficacy of antihypertensive therapies in a "real-world" setting. Studies of this nature can even assess blood pressure control in the early-morning period by sequestering data before and after awakening.