Morning Hypertension: Why Is My Blood Pressure Higher In The Morning?

Your blood pressure is the measurement of force placed on the walls of your arteries as blood moves through your system. High blood pressure, also known as hypertension, means that your heart works harder to pump blood throughout your body, which can put additional strain on the heart.

High blood pressure can also make your arteries lose their elasticity, causing them to harden and thicken, which can lead to serious medical issues like heart disease, heart attack, and stroke.

A blood pressure cuff is used to measure your blood pressure. First, it determines your systolic blood pressure, which measures pressure on the arteries when the heart contracts.

The second is diastolic blood pressure, a reading of the pressure when your heart relaxes in between beats.

Monitoring these two numbers can help your doctor determine the health of your circulatory system, and it may also help them reduce your risk of more severe health conditions.

Your blood pressure readings will change over time. Not only can they go up and down based on your diet and lifestyle, but they even fluctuate throughout the day. The natural body rhythms follow a pattern of higher readings in the daytime and then lower pressures at nighttime when activity is low.

Read on to learn more about what this diagnosis means, how it may affect you, and what treatment options are available.

What is morning hypertension?

Hypertension is the medical term for high blood pressure. Morning hypertension is characterized by abnormally high blood pressure in the first few hours after waking up. While it's common for people to experience higher blood pressure in the morning hours, those with morning hypertension have abnormally high blood pressure. These higher readings usually decrease within a few hours of waking up.

There are two types of morning hypertension:¹

• High blood pressure occurs suddenly in the morning and continues to rise for a period after getting up but then decreases

• High blood pressure throughout the night that is still present in the morning and then decreases

Hypertension can increase your risk of experiencing serious medical emergencies such as heart attack and stroke. Morning hypertension may also put you at an even more increased risk. Researchers are looking into the link between morning hypertension and the fact that more serious cardiac emergencies such as heart attacks occur in the first 4–6 hours after waking up.²

Does blood pressure fluctuate throughout the day?

It's normal for your blood pressure to fluctuate throughout the day, along with your activity levels. You are unlikely to notice these blood pressure changes unless they are dramatic or trigger cardiac or neurologic events.

Doctors know that blood pressure tends to follow a pattern through studies with continuous monitoring. Usually, blood pressure will go up a few hours before waking up. It then rises throughout the morning before reaching its peak around the middle of the day. Afterward, it starts to decline through the late afternoon and evening. It will then reach its lowest levels at night while you are asleep.

Blood pressure that doesn't follow this pattern is more likely to be abnormal. For example, blood pressure levels that don't drop overnight or that remain high throughout the day may indicate you are at increased risk for heart and blood vessel disease and other complications.³

What are the risks of morning hypertension?

If you are diagnosed with morning hypertension, you may be more likely to develop conditions such as:

• Heart attack 

• Stroke⁴

• Aneurysm

• Dementia

• Metabolic issues

• Kidney disease⁵

• Vision loss

All hypertension increases your risk of developing these serious medical conditions, and morning hypertension may make the risk of heart attacks or stroke even higher.⁶ This is particularly true if you already have chronic kidney disease.⁷

If you have high blood pressure or a family history of hypertension, talk to your doctor about monitoring your blood pressure and understanding your treatment options.

What are the causes of high blood pressure in the morning?

Anyone can develop high blood pressure and, for some people, there may not be a clear cause. It may develop over time and could be due to an increased genetic risk. For others, high blood pressure may result from an underlying medical condition. That might include:

• Sleep apnea

• Thyroid problems

• Kidney disease

• Illicit drug use

• Adrenal gland tumors 

• Anxiety disorder⁸

Certain prescription medications can also increase your blood pressure.

If your doctor does discover that you have high blood pressure, they'll try to determine if there is an underlying medical condition causing it. If there is not, which is often the case, they will talk to you about the options for managing your blood pressure to lower your risk of complications.

What are the risk factors for developing morning hypertension?

You may be at an increased risk of developing morning hypertension if:

• You have a family history of high blood pressure

• You are over the age of 60

• You are of Asian, African, or Caribbean descent.¹⁰ It's not clear why people of certain races experience higher rates of hypertension.¹¹

Some lifestyle choices and factors may also increase your risk of developing morning hypertension. These include:

• Smoking  

• Being overweight

• Drinking alcohol

• Not getting enough sleep

• Interrupted sleep patterns

• High amounts of stress or anxiety

Changes to your lifestyle may help bring your blood pressure levels down to normal. This can reduce your risk of developing heart disease and other serious medical conditions. A doctor or cardiologist can help you develop a preventative care plan.

How do I know if I have morning hypertension?

Hypertension is often called the "silent killer." There are usually no noticeable symptoms until it causes a serious medical emergency. Unless you always have routine check-ups with your doctor in the morning, cases of morning hypertension can easily be missed.

The best way to know if you have morning hypertension is through regular blood pressure checks with your doctor in the morning. This will help them document your baseline levels and identify any increases in your blood pressure over time.

Your doctor will put a blood pressure cuff on your arm and inflate it with air to check your blood pressure. It can be performed manually with a stethoscope or by machine. It only takes a few minutes to get the reading, and while having your arm constricted by the cuff may be briefly uncomfortable, it shouldn't hurt.

Your doctor may also recommend wearing an ambulatory 24-hour blood pressure monitor for a few days. This type of monitor will give the most accurate readings and how they fluctuate throughout the day, instead of relying on a single measurement in your doctor’s office. There is evidence that this type of monitoring, along with taking blood pressure medication at night when the pressures are typically lower, can help reduce the risk of a major cardiovascular event.¹²

Your doctor may also order tests to check your heart's activity or request an ultrasound of the heart to rule out any underlying cause for your high blood pressure.

If you have a family history of or risk factors for high blood pressure, you may wish to check your readings between visits to the doctor's office. You can do this by:

• Purchasing a small machine to check your blood pressure at home. These are widely available online, in pharmacies, or through a medical equipment supply company.

• Attending local health fairs. Health fairs and screening events often offer free blood pressure checks and other helpful screening tests for medical conditions.

• Visiting stores and pharmacies that offer blood pressure checks. These are often free or have a minimal charge if done by machine. Ask your local pharmacist if they provide this service or know of a location that does.

Keep track of your blood pressure readings over time, paying particular attention to and recording the time of day they are taken, and bring this record to your next appointment. This can help your doctor determine if your blood pressure readings are any cause for concern. The information can then be used to create a treatment plan for lowering your blood pressure if necessary.

If your blood pressure is higher than 180mm Hg systolic and/or 120mm Hg diastolic, you should contact your doctor immediately or call 911. This is considered a hypertensive crisis and may indicate that you are in danger of experiencing a serious medical emergency.

Tips for managing morning hypertension

If you are diagnosed with morning hypertension, your primary care provider can help you create a treatment plan. They may also work with a cardiologist, especially if your blood pressure is very high, you have a history of heart disease, or someone in your family has high blood pressure.

There are several treatment options for managing morning hypertension. These include:

Lifestyle changes

The most common cause of high blood pressure is lifestyle choices. Making improvements such as changing to a healthier diet, quitting smoking, cutting back on alcohol use, and increasing your aerobic exercise can make a big difference in your blood pressure. Losing weight and learning to manage your stress may also contribute significantly.

Even small changes can result in better blood pressure readings. Your doctor can offer suggestions based on your current lifestyle.

Medications

Medicine to bring your blood pressure down is called antihypertensive medication. There are several options, and your doctor will determine the best one for you.

Some antihypertensive medications can cause blood pressure spikes in the early morning. Because of this, your doctor may recommend a combination of medications to reduce your blood pressure and keep it down over a 24-hour cycle.

If you are prescribed medication for hypertension, talk to your doctor about the best time of the day to take it. Many people take their dose in the morning when their blood pressure is naturally high. This could leave them vulnerable to a medical emergency in the early hours before taking their medication.

Researchers are looking into the effectiveness of timed dosing of long-acting drugs.¹³ Still, one study from Europe found that taking your medication before bed reduced cardiovascular risk.¹⁴ Discuss the options with your doctor, especially if you are diagnosed with morning surge hypertension. 

Signs you should see a healthcare professional

Because people with high blood pressure usually have no signs or symptoms, it can often be difficult to know when to see a healthcare professional. You should talk to your doctor about hypertension and morning hypertension if:

• You have a family history of high blood pressure or heart disease

• You've experienced a heart attack or stroke in the past

• You have sleep apnea, kidney disease, heart disease, or diabetes

• You have risk factors for hypertension such as smoking, obesity, or a sedentary lifestyle

You should also contact your primary care provider immediately if you discover that your blood pressure is above 180/120mm Hg, as this can be a hypertensive emergency.

If you have high blood pressure and are experiencing chest pains, confusion, shortness of breath, or lightheadedness, you should contact 911 or visit your local emergency department.

The lowdown

It's normal for blood pressure to fluctuate within the normal range throughout the day. It typically rises in the morning and peaks around midday before reaching its lowest levels at night while you are asleep. However, some people experience morning hypertension—unusually high blood pressure in the morning.

While all hypertension can lead to serious medical conditions like heart disease and stroke, morning hypertension may increase that risk.

Since there are no reliable external signs or symptoms of high blood pressure, consistent blood pressure readings are the only way to diagnose morning hypertension.

If you are diagnosed with this condition, treatment options include medication and lifestyle changes. Losing weight, changing your diet, increasing your exercise, and cutting back on alcohol and tobacco use can lower your blood pressure levels.

If you have a family history of high blood pressure or heart disease, talk to your doctor about your risk of developing morning hypertension and how to prevent it.