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How to Deal with the Morning Peak Phenomenon of Blood Pressure
Author：Dr.Liu Haixia
Many patients with hypertension find that their blood pressure are obviously higher in the morning than it is at any other time of the day. Some patients only have higher blood pressure in the morning while normal blood pressure in the rest of the day even without taking antihypertensive drugs. What is going on there?
We call this as “Morning peak phenomenon of blood pressure”. To know more of it, we need to understand some of the mechanisms of blood pressure self-regulation. After getting up in the morning, the human body changes from a state of sleep at night to a state of wakefulness during the day, and drastic changes take place inside the body. The autonomic nervous system dominated by parasympathetic nerves during sleep, is rapidly changed into being dominated by sympathetic nerves, which cause accelerated heart rate, vasoconstriction and increased myocardial contractility. After getting up in the morning, the body position changes from supine to uprighttogether with the activation of the sympathetic nervous system caused the activationof the renin - angiotensin aldosterone system (RAAS),which further causing peripheral vascular contraction and sodium retention in blood vessels. The secretion of antidiuretic hormone (also called vasopressin) get peaking during sleeping, which also strongly constricts blood vessels while retaining waterin the body. The combination of these factors peaks in the morning when you wake up, causing what is known as morning peak phenomenonof blood pressure. Morning peak phenomenon may occur in people with normal blood pressure. Mild increases in blood pressure after wake-up in the morning are normal physiological phenomena, but significant increases in blood pressure over 135/85 mmHg may increase the risks of acute cardiovascular and cerebrovascular events .
For patients with morning peakphenomenon of blood pressure , individualized antihypertensive drug use should be adopted. First it is necessary to know the distribution of the blood pressure throughout the day by self-monitoring blood pressure two to four times per day or by 24-hours ambulatory blood pressure monitoring. For patient with elevated blood pressure throughout the day, recommend to take long-acting effect antihypertensive drugs, such as drugs with long half-life or sustained-release dosage forms with long release time. For patient on antihypertensive drugs who has significant elevated blood pressure in the morning while normal blood pressure during the rest of day ,recommend he or she add long-acting effect antihypertensive drugs with shorter half-life (such as angiotensin receptor blockers, beta blockers, alpha blockers drugs)at bed time in the evening or before getting up in the morning to further lower the elevated morning blood pressure.For patients with morning peak phenomenon obviously while the blood pressure relatively much lower in the afternoon, drugs with a short half-life may be added at bed time in the evening orbefore getting up in the morning. In a word, obvious hypotension should be avoided as much as possible during treatment. Long-acting effect antihypertensive drugs should also be recommended for patients with morning peak blood pressure while without low blood pressure during the rest of the day. Antihypertensive drugs with a short half-life often cause sympathetic reflex activation, which may increase the risks of acute cardiovascular and cerebrovascular events. Usually long-acting effect or sustained-release antihypertensive drugs are not likely to cause hypotension to people with normal blood pressure. 
Patients with high blood pressure should pay attention to the morning peak phenomenon, try to monitor blood pressure regularly, record blood pressure during the day , which can help doctor adjust the drugs (types ,doses and administer time) and make a personalized treatment plan for the patient, which can help to avoid the morning peak phenomenon of blood pressure and reduce the incidence of acute cardiovascular and cerebrovascular events.
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