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      Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives

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          Abstract

          It remains uncertain whether abnormal dipping patterns of nocturnal blood pressure influence the prognosis for stroke. We studied stroke events in 575 older Japanese patients with sustained hypertension determined by ambulatory blood pressure monitoring (without medication). They were subclassified by their nocturnal systolic blood pressure fall (97 extreme-dippers, with >/=20% nocturnal systolic blood pressure fall; 230 dippers, with >/=10% but <20% fall; 185 nondippers, with >/=0% but <10% fall; and 63 reverse-dippers, with <0% fall) and were followed prospectively for an average duration of 41 months. Baseline brain magnetic resonance imaging (MRI) disclosed that the percentages with multiple silent cerebral infarct were 53% in extreme-dippers, 29% in dippers, 41% in nondippers, and 49% in reverse-dippers. There was a J-shaped relationship between dipping status and stroke incidence (extreme-dippers, 12%; dippers, 6.1%; nondippers, 7.6%; and reverse-dippers, 22%), and this remained significant in a Cox regression analysis after controlling for age, gender, body mass index, 24-hour systolic blood pressure, and antihypertensive medication. Intracranial hemorrhage was more common in reverse-dippers (29% of strokes) than in other subgroups (7.7% of strokes, P=0.04). In the extreme-dipper group, 27% of strokes were ischemic strokes that occurred during sleep (versus 8.6% of strokes in the other 3 subgroups, P=0.11). In conclusion, in older Japanese hypertensive patients, extreme dipping of nocturnal blood pressure may be related to silent and clinical cerebral ischemia through hypoperfusion during sleep or an exaggerated morning rise of blood pressure, whereas reverse dipping may pose a risk for intracranial hemorrhage.

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          Author and article information

          Journal
          Hypertension
          Hypertension
          Ovid Technologies (Wolters Kluwer Health)
          0194-911X
          1524-4563
          October 2001
          October 2001
          : 38
          : 4
          : 852-857
          Affiliations
          [1 ]From the Department of Cardiology, Jichi Medical School (K.K., S.H., K.S.), Tochigi, Japan; Department of Internal Medicine, Hyogo Prefectural Awaji Hospital (T.M.), Hyogo, Japan; The Zena and Michael A. Weiner Cardiovascular Center, Mount Sinai School of Medicine (K.K., T.G.P.), NY; Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook (J.E.S.).
          Article
          10.1161/hy1001.092640
          11641298
          e84660a9-73eb-4294-a0d8-eae4bd82f35b
          © 2001
          History

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