Hypertension Research · Nov 9, 2026

Winter awakening routine for attenuating the morning blood pressure surge

By Yamamoto K, Miura SI, Kario K

Cardiovascular events cluster in the early morning and peak in winter, when the morning blood pressure surge is accentuated by cold. The Japanese Society of Hypertension has identified the winter morning as a critical window in which cold stress, awakening-related sympathetic activation, physical activity, and arising from bed converge, and has recommended gentle activity such as light stretching and deep breathing on waking, without specifying its content. For a national public broadcaster, under the Society's supervision, we designed a 2-minute routine to be performed in bed after awakening: five slow, deep breaths combined with a whole-body stretch, slow rolling from side to side, ankle circles and ankle pumps, followed by sitting up in stages on the bed and five shoulder-blade lifts combined with slow, deep breathing and gentle neck extension before standing. We describe the physiological rationale for each element, drawing on evidence that the morning rise in blood pressure is related mainly to arising rather than awakening, that slow breathing enhances baroreflex sensitivity, that neck posture modulates carotid sinus input, that the blood pressure response to physical activity predicts the morning surge and is heightened in winter and older age, and that orthostatic hypertension is linked to the surge. The routine is intended to make the rise from the sleep trough to the standing morning blood pressure slower and smoother, and thereby to lower the morning peak. Future studies using ambulatory blood pressure monitoring on winter mornings are needed to test whether the routine attenuates the morning surge.

doi.org/10.1038/s41440-026-02867-3PubMed 43003892Interventions