What does high blood pressure in the morning mean?

Blood pressure refers to the force with which the heart pumps blood around the circulatory system. Several factors can influence blood pressure, including:

• stress or anxiety
• physical activity
• diet

When a person measures their blood pressure, the reading will appear as two numbers. The top number denotes systolic blood pressure, which is the pressure when the heart contracts. The bottom number shows diastolic blood pressure, which is a measure of the pressure when the heart relaxes.

A blood pressure monitor uses a unit of measurement called millimeters of mercury (mm Hg) to measure the pressure inside the blood vessels. Normal blood pressure is less than 120/80 mm Hg.

Readings between 120/80 mm Hg and 139/89 mm Hg indicate that a person is at risk of developing hypertension, while readings of more than 140/90 mm Hg signify hypertension.

Blood pressure rises and falls throughout the day and night. During sleep, blood pressure falls by 10–30%. It then increases around the time of wakening. In some people, this increase may be significant, resulting in morning hypertension.

People who have an abnormal blood pressure pattern may be at risk of complications, such as heart attack and stroke. As a 2010 review notes, the onset of stroke and other serious cardiac events peaks in the first 4–6 hours after waking.

Causes

Some potential causes of morning hypertension include those below.

Medication

Some people take antihypertensive medications to control their blood pressure. According to a 2018 review, uncontrolled morning hypertension may indicate a problem with the type or dosage of these medications.

Specifically, morning hypertension may be due to one or more of the following factors:

• taking a medication dosage that is too low
• taking short-acting or intermediate-acting medications rather than long-acting medications
• taking a single antihypertensive medication rather than a combination of medications

Some people may find that taking their medications before bed rather than in the morning provides better blood pressure control. Others may need to split their daily dose, taking half in the morning and half before bed. In some cases, a person may need to change to another type of blood pressure drug altogether.

It is important to speak to a doctor before making any changes to medications.

Medical conditions

Certain medical conditions may increase the risk of hypertension. These include:

• untreated high blood pressure
• high cholesterol
• cardiovascular disease
• obstructive sleep apnea
• diabetes
• thyroid disorders
• Cushing's syndrome
• lupus
• scleroderma
• kidney disease

Lifestyle factors

Certain lifestyle factors can also increase the risk of hypertension. Examples include:

• smoking
• heavy alcohol consumption
• eating a diet high in salt and saturated fat
• not getting enough exercise

Who is at risk?

The following factors can increase a person's risk of developing morning hypertension:

• being over the age of 65 years
• being of African or Caribbean descent
• having a relative with high blood pressure
• having overweight or obesity
• drinking alcohol
• smoking
• anxiety or excessive stress
• insufficient sleep
• disturbed sleep, for example, working night shifts

When and how to measure blood pressure

Regular use of a home blood pressure monitor can help people better understand their blood pressure fluctuations. It can also allow people to identify episodes of morning hypertension.

The American Heart Association (AHA) recommend using a cuff-style blood pressure monitor. These monitors are more reliable than monitors that attach to the finger or wrist.

The AHA also provide the following guidelines for measuring blood pressure at home:

Before measuring blood pressure:

• Empty the bladder.
• Rest comfortably and quietly for 5 minutes before measuring blood pressure.
• Avoid smoking, drinking alcohol, or exercising within 30 minutes of measuring blood pressure.

When measuring blood pressure:

• Take readings at the same time each day.
• Sit with the back straight, legs uncrossed, and feet flat on the floor.
• Rest the arm on a flat surface so that the upper arm is at heart level.
• Place the cuff on the arm so that the bottom of the cuff is directly above the elbow crease.
• Take two or three readings approximately 1 minute apart and calculate the average value.
• Keep a record of all readings, as this can help a doctor determine the best course of treatment. 

Source: https://www.medicalnewstoday.com/articles/327151.php#normal-pattern