Home Monitoring Helps Control Morning Hypertension Associated with Increased Risk of Stroke

The alarm goes off. The sun is shining. The birds are chirping. And for many clients, blood pressure also might be rising.

High blood pressure (hypertension) is diagnosed when average systolic pressure (the top number in a blood pressure reading) is 140 millimeters or mercury (mmHg) or greater, or average diastolic pressure (bottom number) is 90 mmHg or greater. —American Heart Association

In some individuals, blood pressure is ruled by circadian rhythms and varies during different times of the day. As a person begins to wake up, very early in the morning, blood pressure starts to rise and continues to rise throughout the morning. In the late morning or early afternoon, blood pressure reaches its peak, and then begins to decline at night. The morning surge in blood pressure is not caused by getting out of bed, but rather by genetic systems that automatically increase blood pressure at a set time in the day.

The morning surge in blood pressure exists in people with normal and high blood pressure, but for those with high blood pressure, morning hypertension could create problems.

According to a 2003 study published in the American Heart Association journal Circulation, lead author Kazuomi Kario, M.D., from the department of cardiology at Jichi Medical School in Tochigi, Japan, says a sharp increase in blood pressure in the morning increases the risk of stroke and is linked to brain lesions known as "silent" strokes among older people with high blood pressure. In the study, Kario concluded that even after adjusting for age and ambulatory blood pressure, the risk of stroke for people with a morning surge was nearly three times higher than for people without the surge.

Those with morning hypertension also experience a number of biological changes associated with circadian rhythms:

  • Increased heart rate
  • Increased secretion of catecholamines, especially norepinephrine, into the blood stream
  • Increased plasma renin activity.

Catecholamines, norepinephrine and plasma rennin are hormones that cause tightening of blood vessels in the body, according to MedicineNet.com. As a result, cardiovascular disease often follows this circadian rhythm.

For these hypertension patients, the morning routine might require a stop at the blood pressure monitor.

Home monitoring helps patients measure true blood pressure at different intervals of the day and create a log to aid physicians in recognizing patterns over time. Paying close attention to changes in blood pressure can help patients prevent stroke and other cardiovascular conditions.

"Morning hypertension is a quiet condition with an enormous impact," said Dr. Annabelle Volgman, associate professor of medicine, Rush Medical College, in a news release. "It's critical that people understand that the first step in determining risk is through home detection. That information can then be shared with a physician to determine further diagnosis or treatment plans."

To help your clients choose the right home monitoring system, consider the following variables:

  • Automatic blood pressure monitors minimize human error and are easy for people with hearing or vision loss to use.
  • Portability makes monitoring possible even away from home.
  • The accuracy of blood pressure monitors, especially automatic versions, must be checked at regular intervals to get the best reading.
  • Children or those with larger arms might require specially sized arm cuffs.
  • Bariatric clients might need a wrist monitor equipped with cuffs that wrap easily. Keep in mind that wrist monitors might not be as accurate as an arm monitor.

Omron Healthcare (www.omronhealthcare.com) recently release a blood pressure monitor for home use that targets morning hypertension. HEM-780 measures blood pressure and detects some types of irregular heartbeats. In addition to storing blood pressure and pulse rate information, the device also stores eight weeks of morning averages and evening averages for up to two users.

For more information on products that monitor high blood pressure and other medical conditions, check out "Elisha's Picks: Diagnostic Equipment" in the November issue of Home Health Products

This article originally appeared in the November 2006 issue of HME Business.

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