The morning surge in blood pressure and heart rate is dependent on levels of physical activity after waking

OBJECTIVE To define the influence of morning physical activity levels on the magnitude of the morning surge in blood pressure and heart rate. DESIGN AND METHODS Blood pressure and physical activity were simultaneously recorded in 420 patients by 24-h monitor and actigraphy. The morning surge was defined as the difference between mean blood pressure and heart rate values in the 4-h periods before and after waking; the trough-to-peak surge in blood pressure was also calculated. These values were regressed on the difference in mean (log transformed) physical activity for the same two periods. The analysis was adjusted for covariates, including age, sex, clinic blood pressure and use of antihypertensive medication, in a multiple linear regression. RESULTS The mean morning surges in blood pressure and heart rate were 23/15(± 13/10) mmHg and 17(± 10) beats/min, respectively. The geometric mean increase in physical activity after waking was 33(± 1.5) units. The magnitudes of the morning surge in systolic blood pressure, diastolic blood pressure and heart rate were all significantly and positively correlated with the difference in mean physical activity before and after waking (P < 0.005). Greater clinic blood pressure was significantly associated with a greater morning surge in blood pressure on physical activity (P < 0.0005). CONCLUSIONS The magnitude of the morning surge is significantly associated with the level of physical activity in the hours after waking. Physical activity should be taken into account when the results of ambulatory blood pressure monitoring are interpreted.