Key result
Non-dipper BP pattern linked to ~386% higher risk of white matter lesions in essential hypertension.
Why the study?
Little is known about the relationship between white matter lesions and altered circadian rhythms of blood pressure in patients with essential hypertension.
Does an altered circadian rhythm of blood pressure (non-dipper or antidipper pattern) increase the risk of white matter lesions in hospitalized patients with essential hypertension?
Cross-Sectional (n=145)
Does an altered circadian rhythm of blood pressure (non-dipper or antidipper pattern) increase the risk of white matter lesions in hospitalized patients with essential hypertension?
Effect estimate: OR 4.855 (95% CI 1.062-22.184)
p-value: p=0.042
In hospitalized patients with essential hypertension, a non-dipper circadian blood pressure pattern and advancing age are independent risk factors for the presence and severity of white matter lesions.
Non-dipper pattern may identify hypertension patients at higher white matter lesion risk; leaves open whether circadian BP modification alters lesions.
Background: White matter lesions (WMLs) are associated with an increased risk of stroke, cognitive impairment, and vascular dementia. Hypertension stands as the most significant modifiable independent risk factor contributing to WMLs. However, little is known about the relationship between WMLs and altered circadian rhythms of blood pressure (BP) in patients with essential hypertension. Methods: This cross-sectional observational study enrolled patients diagnosed with essential hypertension. Participants were stratified into mild, moderate, and severe WMLs subgroups based on Fazekas scale assessments, with a control group of individuals without WMLs. All participants underwent 24-hour ambulatory BP monitoring and were classified according to circadian rhythm patterns: dipper, non-dipper, and antidipper. Comparative analyses were performed on demographic characteristics, ambulatory BP profiles, and circadian rhythm patterns across groups. Univariate analysis and multivariate logistic regression were employed to identify independent risk factors for WMLs. Results: 33 in the control group and 112 in the WMLs group were included. There were significant differences in age, history of diabetes mellitus and cardiovascular disease ( p < 0.05). Compared with the control group, mean 24h systolic BP (SBP), mean daytime SBP (DSBP), and mean nocturnal SBP (NSBP) were greater in the WMLs group, and 24hSBPSD, DSBPSD, DDBPSD, and NSBPSD were greater in the WMLs group ( p < 0.05). The circadian rhythms were significantly different between the WMLs group and the control group ( p < 0.05). Age, non-dipper, and antidipper pattern were found to be independent risk factors for WMLs. Multivariate logistic regression revealed that age (OR 1.128 CI 1.082– 1.175, p < 0.001) and the non-dipper pattern (OR 4.855 CI 1.062– 22.184, p =0.042) were independent risk factors for WMLs. Conclusion: Age and non-dipper and antidipper patterns are associated with an increased risk of WMLs. Non-dipper BP is an independent risk factor for WMLs. Middle-aged and elderly people with primary hypertension with non-dipper BP need to manage and control nocturnal BP.
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Shen et al. (2025) conducted a cross-sectional in essential hypertension (n=145). Non-dipper blood pressure pattern vs. Dipper pattern / Control was evaluated on Presence of white matter lesions (OR 4.855, 95% CI 1.062-22.184, p=0.042). A non-dipper blood pressure pattern was an independent risk factor for white matter lesions in patients with essential hypertension (OR 4.855; 95% CI 1.062-22.184; p=0.042).
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