Morning hypertension (MHT) defined by home blood pressure (BP) measurement has been reported to be a significant predictor of cardiovascular events1 and target organ damage.2,3 Although there is no consensus on the definition of MHT,4 a condition in which BP is specifically higher in the morning than at other times of day, may be regarded as MHT. As the criterion of hypertension based on home BP is 135/85 mm Hg,5 an average BP in the morning of ≥135/85 mm Hg and average BP in the evening of <135/85 mm Hg could be one of the definitions of MHT.1
We have recently demonstrated that the morning-evening difference in self-measured BP at home (MEdif) in systolic BP (SBP) was associated with left ventricular hypertrophy (LVH) and remodeling in untreated hypertensive patients, independent of the average of morning and evening BP (MEave).6 The recent guidelines of home BP have shown that home hypertension should be diagnosed by MEave.7,8 Thus, we hypothesized that home hypertension with an increased MEdif, a condition that we termed morning hypertension, could more precisely reflect the cardiac risk of hypertensive patients. The assessment of left ventricular (LV) geometry, in addition to increased LV mass (LVM), is important in terms of cardiovascular risk stratification. Hypertensive patients with concentric LVH have a higher risk of cardiovascular events than those with any other LV geometric patterns.9 This study was designed to assess whether MHT as defined by both MEdif and MEave can be a determinant of concentric LVH in never-treated hypertensive patients.