doi: 10.1161/hy1001.092640
(Hypertension. 2001;38:852.)
© 2001 American Heart Association, Inc.
Scientific Contributions |
Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives
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.).
Correspondence to Kazuomi Kario, MD, PhD, FACC, FACP. Department of Cardiology, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi, Kawachi, Tochigi, 329-0498, Japan. E-mail kkario{at}jichi.ac.jp
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.
Key Words: elderly • circadian rhythm • stroke • cerebral ischemia • blood pressure monitoring, ambulatory
This article has been cited by other articles:
 |
|
 |
|
  J. Almirall, J. C. Martinez-Ocana, and L. Comas Timing of Antihypertensive Therapy and Circadian Blood Pressure Pattern Hypertension, June 1, 2009; 53(6): e41 - e41. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Newton, A. Sheth, J. Shin, J. Pairman, K. Wilton, J. A. Burt, and D. E. J. Jones Lower Ambulatory Blood Pressure in Chronic Fatigue Syndrome Psychosom Med, April 1, 2009; 71(3): 361 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. de la Sierra, J. Redon, J. R. Banegas, J. Segura, G. Parati, M. Gorostidi, J. J. de la Cruz, J. Sobrino, J. L. Llisterri, J. Alonso, et al. Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients Hypertension, March 1, 2009; 53(3): 466 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.R Fernandez, R.C Hermida, and A Mojon Chronobiological analysis techniques. Application to blood pressure Phil Trans R Soc A, January 28, 2009; 367(1887): 431 - 445. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Eguchi, T. G. Pickering, J. E. Schwartz, S. Hoshide, J. Ishikawa, S. Ishikawa, K. Shimada, and K. Kario Short Sleep Duration as an Independent Predictor of Cardiovascular Events in Japanese Patients With Hypertension Arch Intern Med, November 10, 2008; 168(20): 2225 - 2231. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Grassi, G. Seravalle, F. Quarti-Trevano, R. Dell'Oro, M. Bombelli, C. Cuspidi, R. Facchetti, G. Bolla, and G. Mancia Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives Hypertension, November 1, 2008; 52(5): 925 - 931. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Bankir, M. Bochud, M. Maillard, P. Bovet, A. Gabriel, and M. Burnier Nighttime Blood Pressure and Nocturnal Dipping Are Associated With Daytime Urinary Sodium Excretion in African Subjects Hypertension, April 1, 2008; 51(4): 891 - 898. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kunieda, T. Minamino, K. Miura, T. Katsuno, K. Tateno, H. Miyauchi, S. Kaneko, C. A. Bradfield, G. A. FitzGerald, and I. Komuro Reduced Nitric Oxide Causes Age-Associated Impairment of Circadian Rhythmicity Circ. Res., March 14, 2008; 102(5): 607 - 614. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Burr, E. Dolan, E. W. O'Brien, E. T. O'Brien, and P. McCormack The value of ambulatory blood pressure in older adults: the Dublin outcome study Age Ageing, March 1, 2008; 37(2): 201 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Li, J. A. Staessen, L. Lu, L.-H. Li, G.-L. Wang, and J.-G. Wang Is Isolated Nocturnal Hypertension a Novel Clinical Entity?: Findings From a Chinese Population Study Hypertension, August 1, 2007; 50(2): 333 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. B. White The Riskiest Time for the Brain: Could the Nighttime Be the Right Time for Intervention? Hypertension, June 1, 2007; 49(6): 1215 - 1216. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Staessen, T. Richart, and W. H. Birkenhager Less Atherosclerosis and Lower Blood Pressure for a Meaningful Life Perspective With More Brain Hypertension, March 1, 2007; 49(3): 389 - 400. [Full Text] [PDF]
|
|
|
|
|
|
T. Minamino and I. Komuro Vascular Cell Senescence: Contribution to Atherosclerosis Circ. Res., January 5, 2007; 100(1): 15 - 26. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Metoki, T. Ohkubo, and Y. Imai Response to Diurnal Blood Pressure Changes in Stroke Subtypes Hypertension, June 1, 2006; 47(6): e27 - e27. [Full Text] [PDF]
|
|
|
|
|
|
G. Tsivgoulis, K. Spengos, and N. Zakopoulos Diurnal Blood Pressure Changes in Stroke Subtypes Hypertension, June 1, 2006; 47(6): e26 - e26. [Full Text] [PDF]
|
|
|
|
|
|
M. B. Davidson, J. K. Hix, D. G. Vidt, and D. J. Brotman Association of Impaired Diurnal Blood Pressure Variation With a Subsequent Decline in Glomerular Filtration Rate. Arch Intern Med, April 24, 2006; 166(8): 846 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kunieda, T. Minamino, T. Katsuno, K. Tateno, J.-i. Nishi, H. Miyauchi, M. Orimo, S. Okada, and I. Komuro Cellular Senescence Impairs Circadian Expression of Clock Genes In Vitro and In Vivo Circ. Res., March 3, 2006; 98(4): 532 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Ernst, B. L. Carter, C. J. Goerdt, J. J.G. Steffensmeier, B. B. Phillips, M. B. Zimmerman, and G. R. Bergus Comparative Antihypertensive Effects of Hydrochlorothiazide and Chlorthalidone on Ambulatory and Office Blood Pressure Hypertension, March 1, 2006; 47(3): 352 - 358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Metoki, T. Ohkubo, M. Kikuya, K. Asayama, T. Obara, J. Hashimoto, K. Totsune, H. Hoshi, H. Satoh, and Y. Imai Prognostic Significance for Stroke of a Morning Pressor Surge and a Nocturnal Blood Pressure Decline: The Ohasama Study Hypertension, February 1, 2006; 47(2): 149 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Parati and M. Valentini Prognostic Relevance of Blood Pressure Variability Hypertension, February 1, 2006; 47(2): 137 - 138. [Full Text] [PDF]
|
|
|
|
|
|
E. Dolan, A. Stanton, L. Thijs, K. Hinedi, N. Atkins, S. McClory, E. D. Hond, P. McCormack, J. A. Staessen, and E. O'Brien Superiority of Ambulatory Over Clinic Blood Pressure Measurement in Predicting Mortality: The Dublin Outcome Study Hypertension, July 1, 2005; 46(1): 156 - 161. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Iida, G. L. Baumbach, J. L. Lavoie, F. M. Faraci, C. D. Sigmund, and D. D. Heistad Spontaneous Stroke in a Genetic Model of Hypertension in Mice Stroke, June 1, 2005; 36(6): 1253 - 1258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Birns, H. Markus, and L. Kalra Blood Pressure Reduction for Vascular Risk: Is There a Price To Be Paid? Stroke, June 1, 2005; 36(6): 1308 - 1313. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hiroki, T. Uema, N. Kajimura, K. Ogawa, M. Nishikawa, M. Kato, T. Watanabe, T. Nakajima, H. Takano, E. Imabayashi, et al. Cerebral white matter blood flow is constant during human non-rapid eye movement sleep: a positron emission tomographic study J Appl Physiol, May 1, 2005; 98(5): 1846 - 1854. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Sega, R. Facchetti, M. Bombelli, G. Cesana, G. Corrao, G. Grassi, and G. Mancia Prognostic Value of Ambulatory and Home Blood Pressures Compared With Office Blood Pressure in the General Population: Follow-Up Results From the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study Circulation, April 12, 2005; 111(14): 1777 - 1783. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. A. Zakopoulos, G. Tsivgoulis, G. Barlas, C. Papamichael, K. Spengos, E. Manios, I. Ikonomidis, V. Kotsis, I. Spiliopoulou, K. Vemmos, et al. Time Rate of Blood Pressure Variation Is Associated With Increased Common Carotid Artery Intima-Media Thickness Hypertension, April 1, 2005; 45(4): 505 - 512. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Negishi, J.-W. Xu, K. Ikeda, M. Njelekela, Y. Nara, and Y. Yamori Black and Green Tea Polyphenols Attenuate Blood Pressure Increases in Stroke-Prone Spontaneously Hypertensive Rats J. Nutr., January 1, 2004; 134(1): 38 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Verdecchia, F. Angeli, and R. Gattobigio Clinical Usefulness of Ambulatory Blood Pressure Monitoring J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S30 - 33. [Abstract] [Full Text]
|
|
|
|
|
|
K. Eguchi, K. Kario, and K. Shimada Greater Impact of Coexistence of Hypertension and Diabetes on Silent Cerebral Infarcts Stroke, October 1, 2003; 34(10): 2471 - 2474. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Clement, M. L. De Buyzere, D. A. De Bacquer, P. W. de Leeuw, D. A. Duprez, R. H. Fagard, P. J. Gheeraert, L. H. Missault, J. J. Braun, R. O. Six, et al. Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension N. Engl. J. Med., June 12, 2003; 348(24): 2407 - 2415. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kario, T. G. Pickering, Y. Umeda, S. Hoshide, Y. Hoshide, M. Morinari, M. Murata, T. Kuroda, J. E. Schwartz, and K. Shimada Morning Surge in Blood Pressure as a Predictor of Silent and Clinical Cerebrovascular Disease in Elderly Hypertensives: A Prospective Study Circulation, March 18, 2003; 107(10): 1401 - 1406. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Higashi, K. Nakagawa, M. Kimura, K. Noma, K. Hara, S. Sasaki, C. Goto, T. Oshima, K. Chayama, and M. Yoshizumi Circadian variation of blood pressure and endothelial function in patients with essential hypertension: a comparison of dippers and non-dippers J. Am. Coll. Cardiol., December 4, 2002; 40(11): 2039 - 2043. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kario, K. Eguchi, S. Hoshide, Y. Hoshide, Y. Umeda, T. Mitsuhashi, and K. Shimada U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: Orthostatic hypertension as a new cardiovascular risk factor J. Am. Coll. Cardiol., July 3, 2002; 40(1): 133 - 141. [Abstract] [Full Text] [PDF]
|
|