Blood pressure fluctuates naturally throughout the day and tends to increase around the time a person wakes up. However, for many people, blood pressure may be abnormally high in the mornings. Doctors refer to this as morning hypertension.

Morning hypertension can increase the risk of heart attack and stroke. These medical emergencies often occur in the early hours when blood pressure rises.

In this article, we explore the causes and effects of morning hypertension. We also look at ways in which people can prevent and control this condition.

Causes
Some potential causes of morning hypertension include those below.

Medication
Some people take antihypertensive medications to control their blood pressure. According to a 2018 review, uncontrolled morning hypertension may indicate a problem with the type or dosage of these medications.

Specifically, morning hypertension may be due to one or more of the following factors:

taking a medication dosage that is too low
taking short-acting or intermediate-acting medications rather than long-acting medications
taking a single antihypertensive medication rather than a combination of medications
Some people may find that taking their medications before bed rather than in the morning provides better blood pressure control. Others may need to split their daily dose, taking half in the morning and half before bed. In some cases, a person may need to change to another type of blood pressure drug altogether.

It is important to speak to a doctor before making any changes to medications.

Medical conditions
Certain medical conditions may increase the risk of hypertension. These include:

untreated high blood pressure
high cholesterol
cardiovascular disease
obstructive sleep apnoea
diabetes
thyroid disorders
Cushing’s syndrome
lupus
scleroderma
kidney disease
Lifestyle factors
Certain lifestyle factors can also increase the risk of hypertension. Examples include:

smoking
heavy alcohol consumption
eating a diet high in salt and saturated fat
not getting enough exercise

Normal blood pressure pattern
Blood pressure refers to the force with which the heart pumps blood around the circulatory system. Several factors can influence blood pressure, including:

stress or anxiety
physical activity
diet
When a person measures their blood pressure, the reading will appear as two numbers. The top number denotes systolic blood pressure, which is the pressure when the heart contracts. The bottom number shows diastolic blood pressure, which is a measure of the pressure when the heart relaxes.

A blood pressure monitor uses a unit of measurement called millimetres of mercury (mm Hg) to measure the pressure inside the blood vessels. Normal blood pressure is less than 120/80 mm Hg.

Readings between 120/80 mm Hg and 139/89 mm Hg indicate that a person is at risk of developing hypertension, while readings of more than 140/90 mm Hg signify hypertension.

Blood pressure rises and falls throughout the day and night. During sleep, blood pressure falls by 10–30%. It then increases around the time of wakening. In some people, this increase may be significant, resulting in morning hypertension.

People who have an abnormal blood pressure pattern may be at risk of complications, such as heart attack and stroke. As a 2010 review notes, the onset of stroke and other serious cardiac events peaks in the first 4–6 hours after waking.

Who is at risk?
The following factors can increase a person’s risk of developing morning hypertension:

being over the age of 65 years
being of African or Caribbean descent
having a relative with high blood pressure
having overweight or obesity
drinking alcohol
smoking
anxiety or excessive stress
insufficient sleep
disturbed sleep, for example, working night shifts
When and how to measure blood pressure
Regular use of a home blood pressure monitor can help people better understand their blood pressure fluctuations. It can also allow people to identify episodes of morning hypertension.

The American Heart Association (AHA) recommend using a cuff-style blood pressure monitor. These monitors are more reliable than monitors that attach to the finger or wrist.

The AHA also provide the following guidelines for measuring blood pressure at home:

Before measuring blood pressure:

Empty the bladder.
Rest comfortably and quietly for 5 minutes before measuring blood pressure.
Avoid smoking, drinking alcohol, or exercising within 30 minutes of measuring blood pressure.
When measuring blood pressure:

Take readings at the same time each day.
Sit with the back straight, legs uncrossed, and feet flat on the floor.
Rest the arm on a flat surface so that the upper arm is at heart level.
Place the cuff on the arm so that the bottom of the cuff is directly above the elbow crease.
Take two or three readings approximately 1 minute apart and calculate the average value.
Keep a record of all readings, as this can help a doctor determine the best course of treatment.

Symptoms
High blood pressure typically does not cause symptoms, even when levels are dangerously high.

Certain symptoms are more common in people with hypertension. However, they do not necessarily occur as a direct result of hypertension. These symptoms include:

blood spots in the eyes
facial flushing
dizziness
Diagnosis
The diagnosis of high blood pressure in the morning typically relies on a person’s self-reported readings.

Depending on what these readings show, a doctor may recommend a 24 hour blood pressure monitoring test. This test involves wearing a device that takes regular blood pressure readings throughout the day and night.

The doctor will also review the person’s medical history and carry out a physical examination. If necessary, they may order additional tests to confirm or rule out a diagnosis. Examples include:

an echocardiogram, which is an ultrasound of the heart
an electrocardiogram (EKG) to trace the heart’s electrical activity
blood tests
urine tests

Is it dangerous?
People with morning hypertension are at higher risk of cardiovascular events than those with normal morning blood pressure readings.

Getting morning hypertension under control can reduce the risk of heart attack and stroke, among other cardiovascular events.

Treatment
The treatment for morning hypertension involves addressing its underlying cause.

If an underlying medical condition is responsible, treating the condition may help reduce morning hypertension.

If morning hypertension is due to issues with blood pressure medications, a doctor will need to fix this problem. Doing this may involve changing the dosage or the time of the day that the person takes the medication. In some cases, a doctor may recommend taking additional medications.

Some people experience morning hypertension as a result of certain lifestyle factors. People can ask their doctor for information and specific advice on diet, exercise, or quitting smoking.

Anyone who is not already on antihypertensive medications may need to begin taking these drugs.

Prevention and control
Following a healthful lifestyle can help control hypertension in the morning and at other times of the day. Managing hypertension will help lower the risk of complications, such as heart attack and stroke.

Healthful lifestyle behaviours include:

eating a balanced diet that is low in sodium, refined sugar, and saturated fat
limiting alcohol intake
avoiding tobacco
exercising for 90–150 minutes each week
achieving and maintaining a body mass index (BMI) of between 18.5 and 24.9
practicing stress management and relaxation techniques, such as yoga or meditation
taking blood pressure medications according to the prescription
treating any underlying medical conditions that may contribute to hypertension
Summary
Blood pressure fluctuates throughout the day and night. It naturally increases in the hours around waking.

However, abnormally high blood pressure readings in the morning can indicate that a person is at increased risk of cardiovascular events.

Careful monitoring of blood pressure can alert people to instances of morning hypertension. Healthful lifestyle behaviours and prompt medical treatment may help prevent heart attack, stroke, and other complications of hypertension.

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