(Hypertension. 1996;27:130-135.)
© 1996 American Heart Association, Inc.
Articles |
Nocturnal Fall of Blood Pressure and Silent Cerebrovascular Damage in Elderly Hypertensive Patients
Advanced Silent Cerebrovascular Damage in Extreme Dippers
From the Department of Internal Medicine (K.K.), Awaji-Hokudan Public Clinic, Hokudan, Hyogo, Japan; Department of Internal Medicine (K.K., T.M.), Department of Neurology (M.I.), Central Laboratory (M.M., H.K.), Hyogo Prefectural Awaji Hospital, Sumoto, Hyogo, Japan; and Department of Cardiology (K.S.), Jichi Medical School, Tochigi, Japan.
Correspondence to Kazuomi Kario, MD, 480-2, Ikuha, Hokudan, Tsuna, Hyogo, 656-16, Japan.
Abstract To study the relation between diurnal blood pressure
variations and silent cerebrovascular damage, we performed both 24-hour
ambulatory blood pressure monitoring and brain magnetic resonance
imaging in 131 elderly asymptomatic hypertensive
patients. Silent cerebrovascular damage was identified by the magnetic
resonance imaging findings of lacunae (low intensity in
T1-weighted images and high intensity in
T2-weighted images) and advanced
periventricular hyperintense lesions (on
T2-weighted images). The frequency of silent
cerebrovascular damage in the 100 patients with sustained hypertension
was greater than that in the 31 patients with white coat hypertension.
We further classified the former group into nondippers (nocturnal
reduction of systolic pressure by <10% of awake
systolic pressure; n=46), dippers (reduction by 
10% to
<20%; n=38), and extreme dippers (reduction by 20%;
n=16). The
extent of silent cerebrovascular damage was least severe in the dipper
group (P<.05). This J-shaped relation was
not found either with the cardiac hypertrophy detected by
electrocardiography or with the renal damage
assessed by urinary albumin excretion. More than half of the
extreme dippers were patients with isolated systolic
hypertension, and this prevalence was significantly greater than that
in dippers or in nondippers (21% and 30%, respectively). Extreme
dippers also had greater variability of pressure (standard deviation of
awake systolic pressure) than dippers. Our results indicate
that in addition to nondipping, extreme dipping (marked nocturnal fall
of blood pressure) should be considered a type of abnormal diurnal
blood pressure variation in elderly patients with hypertension who are
likely to have advanced silent cerebrovascular damage.
Key Words: blood pressure monitoring • circadian rhythm • elderly • hypertension • cerebrovascular disorders
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