Some of the frequent questions I get asked are, when should someone measure their blood pressure, morning or night? Or is BP higher in the morning, during the day or night? In addition, does it really matter? It does matter, and your risk of disease is affected by all of it.
High blood pressure in the morning can occur for a few reasons. Some of them are typical and usually nothing to worry about. This blog post will inform you of all the causes why it’s higher in the morning. In addition, If your morning BP pattern is untypical, your risk of complications rise. I’ll inform you why and how to correct it.
2 Types Of Morning Hypertension
- Morning Surge High Blood Pressure: This is when blood pressure will increase to a high level in the morning.
- Nocturnal Hypertension: This is high blood pressure throughout the night, without a dip, that carries through into the morning hours.
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High Blood Pressure In The Morning Causes
Typical Blood Pressure Pattern
Blood pressure changes throughout the 24-hour period and follows a pattern. During the night, blood pressure may lower as much as 10% to 30% 1. If you’re having a good sleep, your body and mind relaxes and there are no outside distractions you would experience during the day. In addition, the heart rate decreases.
In the morning you could say, BP wakes up with us as your body experiences changes. Hormone activity like adrenaline increases. An increase in physical movement raises your heart rate. You may experience some form of stress. All the morning activity may cause higher blood pressure 2.
During the day, your blood pressure fluctuates up and down. While performing daily activities, your body is constantly changing positions. In addition your physical exertion changes and your mind can be relaxed one minute and stressed the next 3.
Certain blood pressure fluctuations are the fault of the person. One reason will force you to run to the bathroom which you can read about it in my blog post right here, Fluctuating Blood Pressure.
Some people may experience higher blood pressure in the morning for reasons untypical of the daily pattern. In addition, their blood pressure may increase to a higher measurement than what it would have typically. This can happen for many reasons which leads me to the next topics.
If you’re on blood pressure medication, there are a few reasons why your pressure may be high in the morning:
- Your medication dosage may be too low. By morning time, the dosage may have worn off resulting in higher pressure than what it would have been if the medication was still active.
- The medicine you’re taking may have a shorter or intermediate timeframe for effectiveness. By the morning time, the medication has worn off.
- You may be taking a medication that is not effective for you.
In all 3 circumstances a change in medication or dosage may be your solution. In addition, the time of day you take it may need some modification. Before you attempt to make any changes yourself, always consult with your doctor and explain what is happening to you 4.
A High Sodium Diet
I’ve mentioned it many times in pervious posts. Sodium is actually good for you. It’s when people consume too much of it when it causes problems. Excessive sodium intake can increase fluid retention 5. In addition, it throws the potassium/sodium ratio out of balance. The intake of potassium should be larger than sodium because potassium helps to offset the negative affects of sodium 6.
One study examined 76 people and the effects of sodium on their morning blood pressure. They were given a low salt diet for 7 days and then for the next 7 days a high salt diet. At the end of each 7 day period, their pressure was monitored for 24 hours. The researchers concluded at the end of the high salt diet, the people had higher blood pressure in the morning 7.
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Obstructive Sleep Apnea
Sleep apnea occurs when your breathing is briefly interrupted during sleep. Numerous studies have shown an association between it and high blood pressure. In addition, each one can cause the other one to occur 8.
Studies have shown people with sleep apnea have an increased risk of high blood pressure in the morning 9. In addition, the typical night time dip of blood pressure while your sleeping may not occur. The studies also show a connection between the severity of sleep apnea and how high the blood pressure is in the morning 10.
High Blood Pressure
Having high blood pressure increases your risk of it increasing in the morning. A morning blood pressure rise immediately after waking up, was more common to older people with high blood pressure. A morning surge in blood pressure starting prior to waking up and continuing after waking up, was more common to younger people with high blood pressure 11.
Typically, the more you drink, the higher your risk of developing high blood pressure. The American College of Cardiology recommends men limiting their intake to 2 drinks per day and 1 drink for women. What do they consider 1 drink? It’s equivalent to a 12 ounce beer, 1.5 ounces of spirits or 5 ounces of wine 12.
In addition to raising blood pressure levels, excess alcohol consumption has been associated with high blood pressure in the morning. People who drank excess, were found to have 2.7 times higher risk of morning BP surge 13.
Research has shown a connection between diabetes and a morning surge in blood pressure. An association between diabetes, higher blood sugar levels, insulin resistance and higher morning pressure have been established in studies 14.
The long-term effects of smoking on blood pressure are yet to be determined. Short-term, smoking can increase blood pressure after smoking a cigarette. What is the first thing most smokers do in the morning? If they are like a friend of mine, they have a cigarette first thing after waking up.
One study checked blood pressure after smoking a cigarette in the morning and again later in the afternoon. After the morning cigarette, systolic blood pressure increased 7% while diastolic blood pressure increased 10%. After the afternoon cigarette, systolic increased 3.8% and diastolic changed 1.9% 15. The morning blood pressure increase was much larger than the afternoon increase.
It doesn’t matter what kind, hyper or hypothyroidism is associated with high blood pressure. Studies have shown it is more prevalent with chronic hypothyroidism. In one study, 12 patients were monitored for a 10-month period. Their blood pressure was measured with a 24 hour monitoring device. BP levels were highest in the morning around 9am 16.
This autoimmune disorder can cause hardening of the skin and damage the heart, kidneys, lungs, muscles and joints. It’s an unusual disorder because your body’s immune system attacks your own cells instead of protecting them 17. People with scleroderma don’t typically get the over night dip in pressure, making it higher into the morning hours.
High blood pressure can lead to kidney disease. Uncontrolled blood pressure eventually damages the blood vessels in the kidneys. On the flip side, having chronic kidney disease, can lead to high blood pressure.
People with chronic kidney disease are known to have high blood pressure in the morning. It’s undue to the morning surge most people experience. Studies have shown a sustained higher blood pressure throughout the night without the dip 18.
One of the many complications of Cushing’s syndrome is high blood pressure. The excess cortisol levels experienced affect all tissues and organs of the body. People with Cushing’s syndrome typically have higher cortisol levels in the morning.
High levels of cortisone can constrict blood vessels and raise the heart rate, increasing blood pressure. A woman with Cushing’s syndrome experienced high blood pressure in the morning. After the removal of a tumor, her morning levels significantly reduced 19.
A higher body mass index is associated with higher blood pressure readings during the day or night. A study of over 3,000 people found their morning blood pressure was much higher between 8am and noon, particularly diastolic blood pressure 20.
How High Blood Pressure In The Morning Is Diagnosed
There are a few common ways a doctor will make a diagnosis. The first one is by checking your blood pressure. Your doctor will also examine any home blood pressure measurements you have taken and recorded. If you don’t have a home monitor, or want to update the one you have to a better quality, check out this affordable one I recommend in my blog post by clicking here, Upper Arm Monitor. The manufacturer is used by most hospitals and medical centers and they make a great home monitor.
Next, your doctor may recommend 24-hour ambulatory blood pressure monitoring (ABPM). ABPM involves being outfitted with a device that takes continuous blood pressure readings all day and evening 21. It can be set to measure your BP every 30 minutes or whatever the doctor prefers. ABPM will indicate your exact pressure during the morning hours.
In addition to a physical exam, the following tests may be performed:
- Blood test
- Urine test
- Cat scan
High Blood Pressure In The Morning Complications
Having high blood pressure in the morning carries the same risks as typical high BP but at a greater percentage. Those risks can include the following:
- Cardiovascular disease
- Heart attack
Strokes and Coronary Artery Disease
In one study, high morning BP has been shown as a strong predictor of coronary artery disease and strokes. After researching over 20,000 people with high blood pressure, the number of strokes was significantly higher in people with morning systolic blood pressure equal to or over 145 mmHg when compared to people with less than 125 mmHg.
In addition, the same research found the amount of coronary artery disease was significantly higher in people with the higher systolic blood pressure in the morning 22.
Numerous studies have shown a connection between exaggerated morning BP surge and echocardiographic measures of hypertensive heart disease. The morning surge increased the amount of resistance the heart must overcome when opening the aortic valve. In addition, it contributed to the thickening of the left ventricle chamber’s walls and stiffening of the arteries 23.
Vascular Disease and Inflammation
High blood pressure in the morning has been linked to plaque build-up in the arteries from the heart to the brain. This was observed in people with untreated high BP and may be accompanied by inflammation of the arteries which can cause the plaque build-up 23.
The non dipping night time blood pressure associated with kidney disease (mentioned above in complications), can lead to Microalbuminuria 23. This is when the kidneys leak an increase in the amount of albumin, a protein found in the blood, in the urine. This can signal kidney damage.
The Timing of Coronary Events
Coronary events often occur during the morning hours. This makes BP surges in the morning especially important. A study of 1,273 patients found more strokes occurred in patients were awake during the morning hours from 10:00 AM to noon. This was more than any other 2-hour period and incidence of strokes declined during the remainder of the day 24.
Another study of almost 3,000 people admitted with heart attacks, found the frequency of onset occurred from 6:00 AM to noon 25.
Treatment For High Blood Pressure In The Morning
- A change in medication from short or medium-term medication to longer-term medicines.
- Dosage change.
- Time of day change.
- If not on high blood pressure medication already, this may lead to the doctor writing a prescription for you.
Treating An Underlying Cause
The medical causes listed above, like thyroid problems, will have to be treated. By solving the underlying cause, the morning blood pressure should decrease.
This term is heard of in any blood pressure problem. Excess alcohol, smoking, diet, exercise or more should be addressed to improve the morning surge.
People At Risk For High Blood Pressure In The Morning
The following are risk factors for high blood pressure in the morning:
- High blood pressure
- High cholesterol
- Older than 65-years old
- Excessive use of alcohol
- Family history
- Sleep problems or disorders
- Psychological stress
Read Next: 25 Ways To Lower Blood Pressure Naturally
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- National Center for Biotechnology Information: Sleep and blood pressure
- National Center for Biotechnology Information: Strategies against high blood pressure in the early morning
- National Center for Biotechnology Information: Day/Night Variability in Blood Pressure: Influence of Posture and Physical Activity
- Wiley Online Library: Management of morning hypertension: a consensus statement of an Asian expert panel
- National Center for Biotechnology Information: Effects of changes in dietary sodium intake and saline infusion…
- American Heart Association: Sodium, Potassium, And Stroke
- National Center for Biotechnology Information: Salt-induced exacerbation of morning surge in blood pressure in patients with essential hypertension
- American Collage of Cardiology: Sleep Apnea and High Blood Pressure: A Dangerous Pair
- National Center for Biotechnology Information: The relationship between morning hypertension and sleep quality in patients with obstructive sleep apnea syndrome
- National Center for Biotechnology Information: Blood-pressure variability in patients with obstructive sleep apnea: current perspectives
- Journal of Hypertension: The morning blood pressure surge: a dynamic and challenging concept
- Journal Hypertension: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APHa/ASH/ASPC/NMA/PCNA Guideline…
- Journal Hypertension: Effects of Habitual Alcohol Intake on Ambulatory Blood Pressure, Heart Rate, and Its Variability Among Japanese Men
- National Center for Biotechnology Information: Association between glycemic control and morning blood surge with vascular endothelial dysfunction in type 2 diabetes mellitus patients
- National Center for Biotechnology Information: Effects of cigarette smoking on short-term variability of blood pressure in smoking and non smoking healthy volunteers
- The Journal Of Clinical Endocrinology & Metabolism: The Role of Thyroid Hormone in Blood Pressure Homeostasis: Evidence from Short-Term Hypothyroidism in Humans
- Harvard Health: Scleroderma
- National Center for Biotechnology Information: Morning hypertension chronic kidney disease is sustained type, but not surge type
- National Center for Biotechnology Information: A Cushing’s syndrome patient’s severe insomnia and morning blood pressure surge both improved after her left adrenal tumor resection
- Journal Hypertension: Impact of Obesity on 24-Hour Ambulatory Blood Pressure and Hypertension
- American Heart Association: Task force says 24-hour monitoring best at confirming high blood pressure diagnosis
- National Center for Biotechnology Information: Morning Home Blood Pressure Is a Strong Predictor of Coronary Artery Disease: The HONEST Study
- Journal Hypertension: Morning Surge in Blood Pressure and Cardiovascular Risk
- National Center for Biotechnology Information: Morning increase in onset of ischemic stroke
- National Center for Biotechnology Information: Circadian variation in the frequency of onset of acute myocardial infarction