Home blood pressure control is low during the critical morning hours in patients with hypertension: the SURGE observational study

Background. The morning blood pressure (BP) surge is associated with a peak increase in vascular events. Objective. The aim of this observational study was to evaluate morning BP control in treated hypertensive patients using home BP (HBP) monitoring and to compare these findings with clinic BP control. Methods. Clinic BP was measured twice during a 2-week period, prior to medication. Seated HBP was measured, using a BHS-validated device, three times per day over a 2-week period. Assessments included morning (06:00–11:59), lunchtime (12:00–14:00) and evening (18:00–22:00) HBP control (all <135/85 mmHg) and clinic BP (<140/90 mmHg) control. Results. A total of 15 618 patients were assessed. At baseline (Day 1 and Week 1), clinic BP control (<140/90 mmHg) and morning HBP control (<135/85 mmHg) were low: 23.6% and 21.9%, respectively. The percentage of patients with both clinic BP and morning HBP control was extremely low (8.5%). Similar values were obtained at lunchtime (11.3%) and evening (9.9%). There was a slight improvement at the end of the second week, but values remained low. At final visit (Day 4 and Week 2), morning, lunchtime and evening HBP control was observed in 31.8%, 42.2% and 36.4% of patients, respectively. Clinic BP control was observed in 41.7%. Conclusion. Morning HBP control was low in this large hypertensive population. The improvement in BP control observed may be associated with inclusion in a study; this could indicate low medication compliance in general practices but may also be attributable to the use of agents that cannot sustain 24-hour BP control.