Regression of carotid atherosclerosis by control of morning blood pressure peak in newly diagnosed hypertensive patients

Background: Morning blood pressure (BP) peak may be a risk factor for cardiovascular disease. Whether morn- ing BP should be a target of hypertension treatment is not known. We investigated the relationship between morning BP variations, carotid internal–medial thickness (CIMT), circulating inflammatory markers, and sympathetic activ- ity in hypertensive patients with different patterns of morn- ing BP increase at baseline and after antihypertensive treatment. Methods: One hundred twenty-eight hypertensive pa- tients with morning BP peak (MP) were compared with 196 hypertensive patients without morning BP peak (MP). All patients performed 24-h ambulatory BP mon- itoring, assessment of CIMT, circulating concentration of C-reactive protein (CRP), interleukin-6 (IL-6), interleu- kin-18 (IL-18), and urinary catecholamines. Results: Compared with MP patients, MP patients had higher CIMT and urinary catecholamine output (P .001), as well as CRP, IL-6, and IL-18 (P .001). We randomly assigned 128 drug-naïve MP patients to eithermetoprolol or carvedilol, two antihypertensive drugs with different effects on sympathetic activity. The primary out- come was change in CIMT and circulating inflammatory markers at 12 months. Morning BP decreased more among patients in the carvedilol group (P .001), whereas clinic BP showed a similar decrease in both groups. The CIMT (P .001), IL-6 (P .001), IL-18 (P .001), and CRP (P .001) decreased more in the carvedilol group than in the metoprolol group. The CIMT regression was observed in 49% of patients in the carvedilol group and 18% of patients in the metoprolol group (P .01). Reduction in CIMT was directly associated with changes in morning BP. Conclusions: Higher CIMT and circulating inflamma- tory markers coexist in hypertensive patients with morning BP peak, and might contribute to their increased cardio- vascular risk. Carotid atherosclerosis can be prevented by control of morning BP.