What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke (n=234). Intervention: Nocturnal non-dipping blood pressure vs. Nocturnal dipping blood pressure (>10% decrease). Primary outcome: Presence of Small Vessel Disease (SVD) on MRI (OR 1.95, 95% CI 1.04-3.65, p=0.04).

November 16, 2021Open Access

Night-Time Non-dipping Blood Pressure and Heart Rate: An Association With the Risk of Silent Small Vessel Disease in Patients Presenting With Acute Ischemic Stroke

NANaveed AkhtarGeneral Cardiology SASalman Al-JerdiWeill Cornell Medical College in Qatar SKSaadat KamranWeill Cornell Medical College in Qatar

Key Result

Nocturnal non-dipping of blood pressure was associated with a significantly increased risk of small vessel disease (adjusted OR 1.95) in patients presenting with acute ischemic stroke.

Study Design

Type

Observational (n=234)

Multicenter

Structured PICO

Does nocturnal non-dipping of blood pressure and heart rate associate with an increased risk of silent small vessel disease in patients presenting with acute ischemic stroke?

Population

234 patients presenting with acute ischemic stroke within the initial week of hospital admission, with available 24-h ambulatory blood pressure (ABPM) and MRI data.

Intervention

Nocturnal non-dipping of blood pressure and heart rate (less than 10% nocturnal decrease)

Comparator

Nocturnal dippers of blood pressure and heart rate (more than 10% nocturnal decrease)

Outcome

Presence of Small Vessel Disease (SVD) and silent strokes on MRIsurrogate

Nocturnal non-dipping of blood pressure and heart rate in acute stroke patients is associated with a significantly higher prevalence of silent small vessel disease and silent strokes.

Main Result

Effect estimate: OR 1.95 (95% CI 1.04-3.65)

Absolute Event Rate: 56.8% vs 40.3%

p-value: p=0.04

Limitations

Small sample size for ABPM and 24-hour heart rate measurements
Young patient population with mostly mild lacunar strokes limits generalizability
MRI and ABPM were performed during the same admission
Limited long-term follow-up

Abstract

Background and Purpose: Nocturnal non-dipping blood pressure and heart rate are associated with an increased risk of cardiovascular disease. The effects of such variance on cerebrovascular disease have not been well studied. Methods: The 24-h ambulatory blood pressure (ABPM) and heart rate were monitored with B-pro in patients with acute stroke within the initial week of hospital admission. The risk factor profiles, clinical presentation, imaging, and short-term prognosis were compared in nocturnal dippers and non-dippers (more than 10% nocturnal decrease) of blood pressure and heart rate. Results: We enrolled 234 patients in whom ABPM and MRI data were available. Heart rate data were available in 180 patients. Lacunar sub-cortical stroke was the most common acute lesion (58.9%), while hypertension (74%) and diabetes (41.5%) were the most common associated risk factors. ABPM revealed non-dipping in 69% of patients. On univariate analysis, Small Vessel Disease (SVD) was significantly more frequent in non-dippers vs. dippers (BP: 56.8 vs. 40.3% p = 0.02; heart rate: 57.9 vs. 40.7% p = 0.03). Silent strokes were also more frequent in non-dippers vs. dippers (BP: 40.7 vs. 26.4% p = 0.35; heart rate: 44.6 vs. 25.4% p = 0.01). Multivariate analysis revealed SVD to be significantly related to age, hypertension, blood pressure non-dipping, and severity of symptoms at index event. Conclusions: The presence of nocturnal non-dipping of blood pressure and heart rate are associated with an increased risk of silent stroke and SVD. Increased use of ABPM may allow for improved diagnosis of non-dippers.

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