Morning hypertension: circadian mechanisms, cardiovascular consequences, and emerging therapeutic perspectives

Morning hypertension is increasingly recognized as a contributor to cardiovascular risk, particularly stroke, myocardial infarction, and sudden cardiac death. Several mechanisms have been implicated, including hyperactivity of the sympathetic nervous system, stimulation of the renin–angiotensin–aldosterone system, loss of normal nocturnal dipping, endothelial dysfunction, and disturbances in hormonal regulation. For its management, long-acting antihypertensive agents, such as calcium channel blockers and angiotensin receptor blockers, help sustain 24-hour blood‑pressure control and blunt early‑morning surges. Lifestyle approaches, including improved sleep hygiene, regular physical activity, stress reduction, and dietary modification, also remain important. Despite these approaches, morning hypertension is still not consistently addressed in routine clinical care. Looking forward, research priorities should include standardization of diagnostic thresholds, careful evaluation of chronotherapy, investigation of novel drug classes, and integration of digital health and AI-supported monitoring. Addressing these gaps may be critical for improving cardiovascular risk stratification and treatment outcomes in hypertensive populations.