Kario Kazuomi, White William B
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical School, Yakushiji, Minamikawachi-cho, Kawachi, Tochigi, Japan.
J Am Soc Hypertens. 2008 Nov-Dec;2(6):397-402. doi: 10.1016/j.jash.2008.05.004. Epub 2008 Jul 23.
The early morning surge in blood pressure (BP) in patients with hypertension is associated with an increased risk of cardiovascular events, such as myocardial infarction and stroke, especially in the presence of comorbidities of diabetes, cardiac and renal disease. A variety of nonhemodynamic factors contribute to the early morning prothrombotic state, including increased atherothrombotic plaque vulnerability and endovascular shear stress, increased coagulability, platelet aggregation, and blood viscosity, and reduced fibrinolysis. In addition, there is a strong association between morning hypertension and vascular damage throughout the circulation, which may involve the myocardium, large arteries, and other target organs. Because morning hypertension is often unrecognized, the resultant target-organ damage may progress relentlessly. With recent advances in ambulatory BP monitoring and BP self-measurement and the inclusion of antihypertensive agents that target the underlying pathophysiological mechanisms related to the morning BP surge (ie, the sympathetic nervous system and the renin-angiotensin-aldosterone system), control of morning hypertension is clinically feasible and should be an important therapeutic target.
高血压患者清晨血压激增与心血管事件风险增加相关，如心肌梗死和中风，尤其是在合并糖尿病、心脏和肾脏疾病时。多种非血流动力学因素导致清晨血栓前状态，包括动脉粥样硬化血栓形成斑块易损性增加和血管内剪切应力增加、凝血性增加、血小板聚集和血液黏稠度增加以及纤溶降低。此外，清晨高血压与整个循环系统的血管损伤之间存在密切关联，这可能涉及心肌、大动脉和其他靶器官。由于清晨高血压常常未被识别，由此导致的靶器官损害可能会持续进展。随着动态血压监测和血压自我测量的最新进展，以及纳入针对与清晨血压激增相关的潜在病理生理机制（即交感神经系统和肾素-血管紧张素-醛固酮系统）的抗高血压药物，控制清晨高血压在临床上是可行的，并且应该成为一个重要的治疗靶点。
