Downloaded from http://journals.lww.com/bpmonitoring by BhDMf5ePHKbH4TTImqenVAOAOkVIYvX47GxRYvU3n94ZyvTEhp4oG5aAWMQQ6YUG on 10/20/2020 Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Original article 121 1359-5237 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MBP.0000000000000440 Morning blood pressure surge and diastolic dysfunction in patients with masked hypertension Samet Yilmaz a , Gökay Nar a , Aysen Til b and Asuman Kaftan a Objectives In this study, we evaluated the association between morning blood pressure surge (MBPS) levels and diastolic function parameters in patients with masked hypertension (MH). Methods A total of 92 patients with diagnosis of MH were enrolled in the study. Patients were divided into three groups according to their MBPS levels. Cardiac dimensions, left atrial volume and ejection fraction were determined by transthoracic echocardiography. A two- dimensional Doppler echocardiogram was performed to evaluate diastolic function parameters including transmitral E-wave and A-wave velocity, mitral annular E′ and A′ velocity, E wave deceleration time and isovolumic relaxation time. Results Mean MBPS value of the total study population was 25.1 ± 6.4 mmHg. When going from the lowest MBPS group to the higher MBPS groups; E velocity [0.75 (0.74–0.77) vs. 0.71 (0.69–0.73) vs. 0.68 (0.66–0.69) cm/s, respectively] E/A ratio [1.44 (1.40–1.48) vs. 1.35 (1.32–1.39) vs. 1.26 (1.23–1.29), respectively] and E′ velocity [0.114 (0.111–0.117) vs. 0.102 (0.100–0.105) vs. 0.093 (0.089–0.096) cm/s, respectively] were significantly decreased. E/E’ ratio [7.3 (6.9–7.7) vs. 6.6 (6.4–7.9), P = 0.002] and left atrial volume index [27.24 (25.5–28.9) vs. 21.90 (21.0–22.7) ml/m 2 , P < 0.001] were significantly higher in the highest MBPS tertile than the lowest tertile. There was a positive correlation between E/E’ ratio and MBPS values (r = 0.306, P = 0.003). Conclusion Increased MBPS levels were found to be related with deterioration of diastolic function parameters in patients with MH. Blood Press Monit 25: 121–125 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. Blood Pressure Monitoring 2020, 25:121–125 Keywords: diastolic dysfunction, masked hypertension, morning blood pressure surge a Cardiology Department, Pamukkale University Faculty of Medicine and b Public Health Department, Pamukkale University Faculty of Medicine, Denizli, Turkey Correspondence to Samet Yilmaz, MD, Cardiology Department, Pamukkale University Faculty of Medicine, 20100 Denizli, Turkey Tel: +0090 (507) 3055883; fax: +0090 (258) 2965748; e-mail: sametyilmazmd@gmail.com Received 12 December 2018 Accepted 4 February 2020 Introduction Hypertension, which is defned as a high blood pressure, is mostly diagnosed by offce blood pressure measure- ment. However, some patients with normal blood pres- sure levels in offce setting have elevated blood pressure in ambulatory blood pressure monitoring (ABPM) and this is known as masked hypertension (MH) [1]. Recent studies have shown that MH increases cardiovascular (CV) risks similar to sustained hypertension and related to adverse CV events [2]. Morning blood pressure surge (MBPS) is an increase of blood pressure levels after wake up. Increase of blood pressure during morning hours is related to increased release of adrenocorticotropic hormone and cortisol due to activation of sympathetic system after waking up [3]. In previous studies, it has been shown that increased MBPS is associated with stroke, left ventricular (LV) hypertrophy and arterial stiffness in sustained hyper- tensive patients [4–6]. Furthermore, in patients with syndrome X, MBPS was found to be related with dias- tolic dysfunction [7]. However the relationship between MBPS and diastolic functions in patients with MH has not been studied yet. In this study, we hypothesized that increased MBPS is related to change in diastolic function parameters in patients with MH. Methods A total of 1150 ABPM records between January 2013 and May 2018 were retrospectively analysed. Patients with MH were determined by offce blood pressure measurement <140/90 mmHg and one of the following: ≥130/80 mmHg for 24 hours average blood pressure, ≥135/85 mmHg for daytime average blood pressure and ≥120/70 mmHg for overnight average blood pressure. Exclusion criteria were; history of coronary artery dis- ease, presence of congestive heart failure (ejection frac- tion <50%), any systemic infammatory or rheumatologic disease, thyroid disorder, any rhythm other than sinus rhythm, renal disease, liver disease, pregnancy or lacta- tion, and taking medications that can affect blood pres- sure (steroid, anti-depressant, etc.). After exclusion of patients who did not meet the diagnostic criteria of MH and patients who had one of the exclusion criteria, the remaining 92 patients included in the fnal analysis. The study was approved by the local ethics committee.