Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Morgendlicher Blutdruckanstieg: vor oder nach dem Aufwachen?

Morning blood pressure increase: Before or after waking up?

  • 17 Accesses

  • 11 Citations


The coincidence of the circadian peak of cardiovascular events with the morning blood pressure rise suggests causal connections. Rapidly acting antihypertensives taken before getting up may attenuate the increase early enough, if the onset does not occur before awakening.

In 111 normotensives and in 109 subjects with untreated essential hypertension ambulatory blood pressure monitoring was performed to study whether the onset of the blood pressure rise occurs before or after waking up. The individual 24 h blood pressure profiles obtained by intermittent readings at intervals of 15 minutes were synchronized by the time of waking up.

The resulting blood pressure curves showed no substantial blood pressure rise during sleep, but steep increases after awakening: Within the first hour after waking up blood pressure increased from 107.3+11.4/62.3±9.6 mm Hg (mean+sd) to 121.4±16.0/75.3+12.6 mm Hg in normotension and from 124.7+16.0/72.7+12.2 mm Hg to 140.3+17.2/84.5+13.3 mm Hg in hypertension. The velocity of this increase was dependent on the lag between waking up and getting up. There was no phase difference between early morning blood pressure and heart rate rises.

Thus to attenuate the morning blood pressure increase, rapidly acting drugs after awakening may be considered instead of long acting antihypertensives administered prior to sleep.

This is a preview of subscription content, log in to check access.


  1. 1.

    Alderman MH, Ooi WL, Madhaven S, Cohen H (1989) Treatment-induced blood pressure reduction and the risk of myocardial infarction. JAMA 262:920–924

  2. 2.

    Drayer JIM, Weber MA, Nakamura DK (1985) Automated ambulatory blood pressure monitoring: a study in age-matched normotensive and hypertensive men. Am Heart J 109:1334–1338

  3. 3.

    Jelnes R, Bülow J, Tonnesen KH, Lassen NA, Holstein P (1987) Why do patients with severe arterial insufficiency get pain during sleep? Scand J Clin Lab Invest 47:649–654

  4. 4.

    Littler WA (1979) Sleep and blood pressure: further observations. Am Heart J 97:35–37

  5. 5.

    Millar-Craig MW, Mann S, Balasubramanian V, Altman DG, Raftery EB (1981) Circadian rhythms in hypertension. Scott Med J 26:309–314

  6. 6.

    Muller JE, Stone PH, Turi ZG, Rutherford JD, Czeisler CA, Parker C, Poole WK, Passamani E, Roberts R, Robertson T, Sobel BE, Wilerson JT, Braunwald E, and the MILIS Study Group (1985) Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 313:1315–1322

  7. 7.

    Muller JE, Ludmer PL, Willich SN, Tofler GH, Aylmer G, Klangos I, Stone PH (1987) Circadian variation in the frequency of sudden cardiac death. Circulation 75:131–138

  8. 8.

    Parati G, Pomidossi G, Casadei R, Malaspina D, Colombo A, Ravogli A, Mancia G (1985) Ambulatory blood pressure monitoring does not interfere with the haemodynamic effects of sleep. J Hypertens 3 (Suppl 2):S 107-S 109

  9. 9.

    Peters RW, Muller JE, Goldstein S, Byington R, Friedman LM (1989) Propranolol and the morning increase in the frequency of sudden death (BHAT Study). Am J Cardiol 63:1518–1520

  10. 10.

    Richards AM, Nicholls MG, Espiner EA, Ikram H, Cullens M, Hinton D (1986) Diurnal patterns of blood pressure, heart rate and vasoactive hormones in normal man. Clin Exp Hypertens A 8:153–166

  11. 11.

    Rocco MB, Barry J, Campbell S, Nabel E, Cook EF, Goldman L, Selwyn AP (1987) Circadian variation of transient myocardial ischemia in patients with cornary artery disease. Circulation 75:395–400

  12. 12.

    Rosing DR, Brakman P, Redwoos DR, Goldstein RE, Beiser GD, Astrup T, Epstein S (1970) Blood fibrinolytic activity in man: diurnal variation and the response to varying intensities of exercise. Circ Res 27:171–184

  13. 13.

    Sirgo MA, Mills RJ, DeQuattro V (1988) Effects of antihypertensive agents on circadian blood pressure and heart rate patterns. Arch Intern Med 148:2547–2552

  14. 14.

    Tofler GH, Brezinski DA, Schafer AI, Czeisler CA, Rutherford JD, Willich SN, Gleason RE, Williams GH, Muller JE (1987) Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 316:1514–1518

  15. 15.

    Tsementzis SA, Gill JS, Hitchcock ER, Gill SK, Beevers DG (1985) Diurnal variation of and activity during the onset of stroke. Neurosurgery 17:901–904

  16. 16.

    Willich SN, Levy D, Rocco MB, Tofler GH, Stone PH, Muller JE (1987) Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study Population. Am J Cardiol 60:801–806

  17. 17.

    Willich SN, Linderer T, Wegscheider B, Schroder R, and the ISAM Study Group (1988) Increased risk of myocardial infarction in the morning (Abstr). JACC 11 (Suppl A):28 A

  18. 18.

    Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S (1979) Circadian variation of exercise-induced coronary artery spasm. Circulation 59:938–948

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Baumgart, P., Rahn, K.H. Morgendlicher Blutdruckanstieg: vor oder nach dem Aufwachen?. Klin Wochenschr 68, 320–323 (1990). https://doi.org/10.1007/BF01649023

Download citation

Key words

  • Blood pressure
  • Hypertension
  • Sleep
  • Waking up
  • Antihypertensive therapy