Published Online
on December 27, 2005

A more recent version of this article appeared on February 1, 2006

This Article Full Text (PDF) Data Supplement All Versions of this Article: 47/2/149    most recent 01.HYP.0000198541.12640.0fv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Metoki, H. Articles by Imai, Y. Search for Related Content PubMed PubMed Citation Articles by Metoki, H. Articles by Imai, Y. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Cerebrovascular disease/stroke Acute Cerebral Hemorrhage Acute Cerebral Infarction Epidemiology Related Article

Submitted on July 5, 2005
Revised on July 28, 2005

Prognostic Significance for Stroke of a Morning Pressor Surge and a Nocturnal Blood Pressure Decline. The Ohasama Study

Hirohito Metoki; Takayoshi Ohkubo^*; Masahiro Kikuya; Kei Asayama; Taku Obara; Junichiro Hashimoto; Kazuhito Totsune; Haruhisa Hoshi; Hiroshi Satoh; and Yutaka Imai

From the Departments of Clinical Pharmacology and Therapeutics (H.M., K.A., T.O., K.T., Y.I) and Drug Development and Clinical Evaluation (T.O., M.K., J.H.), Environmental Health Sciences (H.S.), Tohoku University Graduate School of Pharmaceutical Science and Medicine, Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai; and Ohasama Hospital (H.H.), Iwate, Japan.

^* To whom correspondence should be addressed. E-mail: tohkubo{at}mail.tains.tohoku.ac.jp.

Abstract--There is continuing controversy over whether the pattern of circadian blood pressure (BP) variation that includes a nocturnal decline in BP and a morning pressor surge has prognostic significance for stroke risk. In this study, we followed the incidence of stroke in 1430 subjects aged 40 years in Ohasama, Japan, for an average of 10.4 years. The association between stroke risk and the pattern of circadian BP variation was analyzed with a Cox proportional hazards model after adjustment for possible confounding factors. There was no significant association between total stroke risk and the nocturnal decline in BP (percentage decline from diurnal level) or between total stroke risk and the morning pressor surge. The cerebral infarction risk was significantly higher in subjects with a <10% nocturnal decline in BP as compared with subjects who had a 10% nocturnal decline in BP (P=0.04). The morning pressor surge was not associated with a risk of cerebral infarction. On the other hand, an increased risk of cerebral hemorrhage was observed in subjects with a large morning pressor surge (25 mm Hg; P=0.04). Intracerebral hemorrhage was also observed more frequently in extreme dippers (those with a 20% nocturnal decline in BP) than dippers (those with a 10% to 19% decline; P=0.02). A disturbed nocturnal decline in BP is associated with cerebral infarction, whereas a large morning pressor surge and a large nocturnal decline in BP, which are analogous to a large diurnal increase in BP, are both associated with cerebral hemorrhage.

Key words: clinical trials • population • risk factors • blood pressure monitoring • blood pressure monitoring, ambulatory

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