doi: 10.1161/hy1001.092640
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(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
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