[Circadian rhythm of silent myocardial ischemia. Why morning is so risky for hypertensive patients]. / Zirkadiane Rhythmik der stummen Myokardischämie. Warum der Morgen für Hypertoniker so gefährlich ist.

ABSTRACT

The circadian pattern of numerous cardiovascular events (myocardial infarction, sudden cardiac death, stroke) reveals a peak in the early hours of the morning. A circadian rhythm peaking in the morning is also found for so-called silent myocardial ischaemia, which occurs in more than 20% of patients with arterial hypertension, and can be regularly detected in combined 24-h-ABPM/EKG examinations. Comparative studies have shown that hypertensives with SMI suffer more cardiac events than those with no SMI. It has further been demonstrated that an elevated blood pressure amplitude, with is considered an independent risk factor for cardiac events, is associated with an increased incidence of SMI in patients with micro- or macro-angiopathy. Accordingly, consideration should be given to SMI when deciding on treatment, also in hypertensives with no angina pectoris symptoms.