What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=524). Intervention: Reverse-dipper blood pressure pattern vs. Dipper blood pressure pattern. Primary outcome: Mild carotid stenosis (1%-24% narrowing) compared to no plaque (OR 2.500, 95% CI 1.320-4.736, p=0.005).

March 1, 2015Open Access

Blood Pressure Reverse-Dipping is Associated With Early Formation of Carotid Plaque in Senior Hypertensive Patients

Key Result

Reverse-dipper pattern of blood pressure was significantly associated with the early formation of mild carotid plaque (OR 2.500) compared to normal carotid arteries in hypertensive patients.

Study Design

Type

Cross-Sectional (n=524)

Multicenter

Structured PICO

Is a reverse-dipper pattern of blood pressure associated with early formation of carotid plaque in hypertensive patients?

Population

524 hypertensive patients

Intervention

Reverse-dipper pattern of blood pressure on ambulatory BP monitoring

Comparator

Other blood pressure dipping patterns

Outcome

Degree of carotid plaque (Grade 0: normal/no plaque, Grade 1: mild stenosis 1%-24%, Grade 2: moderate stenosis ≥25%)surrogate

A reverse-dipper pattern of blood pressure is associated with early formation of carotid plaque in hypertensive patients, suggesting it may be a risk factor for carotid atherosclerosis.

Main Result

Effect estimate: OR 2.500 (95% CI 1.320-4.736)

p-value: p=0.005

Limitations

Cross-sectional design cannot confirm direct causal relationships.
Study population was limited to Northern Chinese patients with essential hypertension, limiting generalizability to other ethnic groups or nonhypertensive patients.
Only a single 24-hour ambulatory blood pressure monitoring was used, whereas multiple monitorings over time might provide more prognostic information.
Lack of patients with severe carotid stenosis (>70% narrowing) in the study cohort.

Abstract

Nocturnal variations in blood pressure (BP) were associated with carotid intima-media thickness. However, the precise relationship between circadian variations of BP and carotid plaques remains unknown. Therefore, the prognostic value of reverse-dipper pattern of BP for carotid plaque was investigated. In this cross-sectional study, a total of 524 hypertensive patients were recruited and evaluated with ambulatory BP monitoring between April 2012 and June 2013. Carotid plaque was classified into Grade 0 (normal or no observable plaque), Grade 1 (mild stenosis, 1%-24% narrowing), and Grade 2 (moderate stenosis, ≥25% narrowing). Multinomial logistic regression was applied to analyze the relationship between different degrees of carotid plaque and ambulatory BP monitoring results. Reverse-dipper pattern of BP was more common in older patients, smokers, and those with elevated fasting glucose. The incidences of coronary artery disease, lacunar infarction, and diabetes were also higher among hypertensive with reverse-dipper pattern. Multinomial logistic regression analysis showed that reverse dipper (odds ratio OR 2.500; 95% confidence interval CI 1.320-4.736; P = 0.005), age (OR 1.089; 95% CI 1.067-1.111; P < 0.001), smoke (OR 1.625; 95% CI 1.009-2.617; P = 0.046), and diabetes (OR 1.759; 95% CI 1.093-2.830; P = 0.020) were significantly different between mild carotid plaque and normal. Our results also suggested that mild carotid plaque was closely related to reverse-dipper pattern of BP (2.308; 95% CI 1.223-4.355; P = 0.010). Reverse-dipper pattern of BP may be a risk factor for carotid atherosclerosis and play a crucial role in the early formation of carotid plaque.

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