While the study design and methods are not as rigorous as contemporary protocols, the results are remarkable with similar patterns noted with respect to the timing of myocardial infarction and sudden cardiac death.
-Mechanisms include documented elevations in sympathetic activity (vascular tone and adrenaline) as well as transient increases in platelet aggregation and coagulation parameters during the "morning surge."
-As such, there is consensus that morning pressures are the most important to control; they are both the highest readings of the day and those most tightly linked with cardiovascular events.
-I control morning BP by using long acting agents (chlorthalidone, amlodipine,
) or dosing medications at night.