Published online before print December 27, 2005, doi: 10.1161/01.HYP.0000198541.12640.0f
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(Hypertension. 2006;47:149.)
© 2006 American Heart Association, Inc.
Original Articles |
Prognostic Significance for Stroke of a Morning Pressor Surge and a Nocturnal Blood Pressure Decline
The Ohasama Study
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.
Correspondence to Takayoshi Ohkubo, Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan. E-mail tohkubo{at}mail.tains.tohoku.ac.jp
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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