Hypertension is a common chronic disease affecting nearly one-third of the adult population and an important predictor of cardiovascular morbidity and mortality. Blood pressure is inherently variable and depends on an individual’s physiological state and numerous situational factors. Conventional office recordings to diagnose and monitor a patient’s progress and response to treatment is notoriously restrictive. The harmful effects of hypertension are presumed to be due to a prolonged, elevated average BP. Both ambulatory and home blood pressure monitoring are increasingly adopted in clinical practice to eliminate “white coat” and “masked” hypertension and may also be a better prognostic indicator of cardiovascular events than office values. There remain limitations in access and cost to replacing office BP measurements with out-of-office monitoring modalities. Blood pressure also displays a normal circadian variation with nocturnal dipping and a morning surge. Blunted nocturnal dipping and an exaggerated morning surge are thought to correlate with increased cardiovascular events. The pathogenic mechanisms underlying this phenomenon are not well understood. The threshold above which the morning surge becomes pathological is also unclear. More clinical studies targeting treatment of an exaggerated surge are also necessary before clinicians can attribute more weight towards its prognostic importance.