# Association Between Morning Blood Pressure Surge and Tinnitus in Hypertensive Patients: A Cross-Sectional Study

## TL;DR

This study finds that a sharp rise in blood pressure in the morning is linked to tinnitus in people with high blood pressure.

## Contribution

The study is the first to explore the association between morning blood pressure surge and tinnitus in hypertensive patients.

## Key findings

- Patients with tinnitus had significantly higher morning blood pressure surges than those without tinnitus.
- Morning blood pressure surge was a stronger predictor of tinnitus than other blood pressure parameters.
- A morning blood pressure surge above 28 mm Hg predicted tinnitus with 73.3% sensitivity and 68.3% specificity.

## Abstract

Background and Objectives: Despite extensive research into its vascular mechanisms, the relationship between tinnitus and morning blood pressure surge (MBPS) remains unexplored. This study aims to investigate the association between tinnitus and MBPS in hypertensive patients. Materials and Methods: The study included 266 hypertensive patients, 86 with tinnitus and 180 without. Office blood pressure (BP) measurements, 24 h ambulatory BP monitoring (ABPM), echocardiographic findings, and laboratory parameters were analyzed. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI). MBPS was calculated as the difference between the average systolic BP (SBP) in the first two hours after waking and the lowest three SBP values measured during sleep. Statistical analyses included regression models, ROC curve analysis, and the Boruta feature selection method. Results: MBPS was significantly higher in the tinnitus group compared to the non-tinnitus group (35 ± 9 vs. 26 ± 11 mm Hg, p < 0.001). Office BP and ABPM were significantly lower in the tinnitus group, while DBP showed no differences. The regression analysis identified MBPS (OR = 1.15, 95% CI: 1.08–1.23, p < 0.001), SBP (OR = 1.09, 95% CI: 1.03–1.15, p = 0.004), age (OR = 0.89, 95% CI: 0.82–0.96, p = 0.003), and smoking status (OR = 3.54, 95% CI: 1.09–11.61, p = 0.037) as independent predictors of tinnitus. The ROC analysis demonstrated that MBPS >28 mm Hg predicted tinnitus with 73.3% sensitivity and 68.3% specificity (AUC = 0.742, 95% CI: 0.685–0.793, p < 0.001). The comparative analysis showed that MBPS had a superior predictive accuracy for tinnitus compared to other BP parameters (p < 0.001). The 5-fold cross-validated ROC analysis further validated the moderate discriminatory power of MBPS, with an average AUC of 0.735 (95% CI: 0.672–0.798). Conclusions: This study demonstrates a significant association between tinnitus and MBPS in hypertensive patients. MBPS may serve as a useful indicator for identifying patients at risk of tinnitus, highlighting the importance of circadian BP monitoring in clinical practice.