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Unlabelled: The morning blood pressure (BP) rise entails a higher cardiovascular risk. Studies evaluating the association between home BP morning rise and target organ damage are scarce and almost exclusively based on Asians. The aim of our study was to characterize hypertensive patients with morning rise in home BP and to establish a possible association with left ventricular hypertrophy (LVH)., Methods: treated hypertensive patients ≥ 18 years underwent home BP measurements (duplicate measurements for 4 days in the morning, afternoon and evening), and completed a questionnaire regarding risk factors and history of cardiovascular disease. Medical records were reviewed to extract data from grams. A morning rise in systolic home BP was defined as a difference between morning and evening systolic BP averages ≥15 mmHg. Subjects were considered to have LVH if the left ventricular mass index was >95 g/m2 in women and >115 g/m2 in men. Variables identified as relevant predictors of home BP morning rise were entered into a multivariable logistic regression analysis model., Results: 216 patients were included, mean age 68 (+13.3), 69.4% women and 99.1% Caucasians. The prevalence of BP morning rise was 13.4% and independently associated factors were LVH (OR 3.5; 95%CI 1.1-11.4), age (OR 1.05; 95%CI 1.003-1.1) and a history of cerebrovascular disease (OR 3.9; 95%CI 1.1-14.2). In conclusion, a morning rise in systolic BP detected through home BP monitoring is independently associated with LVH, age and a history of cerebrovascular disease. The therapeutic implications of this observation need to be clarified in large-scale prospective studies.

HBPM guidelines state that morning and evening measurements should be recorded and, to improve stability, the first day of measurements should be discarded. Our objective was to assess the reproducibility and reliability of a 4-day HBPM protocol with and without first day measurements. We analyzed a retrospective cohort of ambulatory patients who required a HBPM for diagnostic purposes or evaluation of treatment efficacy. A 4-day protocol was implemented, with daily duplicate measurements in the morning, afternoon and evening, using an OMRON 705 CP validated equipment. HBPM reproducibility was quantified by test-re-test correlations and standard deviation of differences (SDD) between BP measurements obtained during the entire 4 days, with and without exclusion of the first day. The reliability criterion was the stabilization of the mean and standard deviation (SD). We included 353 subjects with a total of 8224 BP recordings (median of 24 recordings per patient). We found a strong test-re-test correlation between days 1 to 4, which improved when we excluded the first day (p<0.001). We also found a reduction of the mean BP when we increased the number of days and a reduction of SDD when we excluded day 1. Therefore, we conclude that the exclusion of the first day of measurements improves the reproducibility and reliability of a 4-day protocol, and such two factors are not affected by the inclusion of afternoon measurements.