Elevated night-time systolic blood pressure was independently associated with silent brain infarcts (OR 1.15 per 10 mmHg, P=0.042) and increased white matter hyperintensity volume (OR 1.21, P=0.003).
Cohort (n=828)
Is night-time systolic blood pressure associated with subclinical cerebrovascular disease in an elderly cohort without prior stroke?
Elevated night-time systolic blood pressure measured by ambulatory monitoring is strongly and independently associated with subclinical cerebrovascular disease, identifying individuals at higher risk for hypertensive brain injury.
Effect estimate: OR 1.15 per 10 mmHg
p-value: p=0.042
AIMS: Although ambulatory blood pressure (BP) is a better predictor of cardiovascular outcomes than office BP, its association with subclinical cerebrovascular disease is not clarified. We investigated the associations of office and ambulatory BP values with subclinical cerebrovascular disease in a population based, predominantly elderly cohort without prior stroke. METHODS AND RESULTS: Eight hundred and twenty-eight participants underwent 24-h ambulatory BP monitoring (ABPM), 2D echocardiography and brain magnetic resonance imaging in the Cardiac Abnormalities and Brain Lesion (CABL) study. Daytime, night-time, and 24-h BPs, nocturnal dipping pattern, morning surge (MS), and 24-h variability were assessed. Subclinical cerebrovascular disease was defined as silent brain infarcts (SBIs) and white matter hyperintensity volume (WMHV). The association of BP measures with the presence of SBI and upper quartile of log-WMHV (log-WMHV4) was analysed. SBIs were detected in 111 patients (13.4%). Mean log-WMHV was -0.99 ± 0.94. In multivariable analysis, only night-time systolic BP (SBP) was significantly associated with SBI odds ratio (OR) 1.15 per 10 mmHg, P = 0.042, independent of cardiovascular risk factors, and pertinent echocardiographic parameters. Although daytime, night-time, 24-h BPs, and non-dipping pattern were all significantly associated with log-WMHV4 (all P < 0.05), night-time SBP showed the strongest association (OR 1.21 per 10 mmHg, P = 0.003) and was the sole independent predictor when tested against the other BP parameters. Office BP measures, MS, and BP variability were not associated with subclinical cerebrovascular disease in adjusted analyses. CONCLUSION: Elevated night-time SBP is strongly associated with subclinical cerebrovascular disease. Night-time SBP by ABPM allows to identify individuals at higher risk of hypertensive brain injury.
Nakanishi et al. (Fri,) conducted a cohort in Subclinical cerebrovascular disease (n=828). Night-time systolic blood pressure vs. Other blood pressure parameters (daytime, 24-h, office BP) was evaluated on Silent brain infarcts (SBIs) (OR 1.15 per 10 mmHg, p=0.042). Elevated night-time systolic blood pressure was independently associated with silent brain infarcts (OR 1.15 per 10 mmHg, P=0.042) and increased white matter hyperintensity volume (OR 1.21, P=0.003).