January 1, 1996Hypertension623 citations
Nocturnal Fall of Blood Pressure and Silent Cerebrovascular Damage in Elderly Hypertensive Patients
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Key Result
Extreme dipping and nondipping of nocturnal blood pressure were associated with more severe silent cerebrovascular damage compared to normal dipping in elderly hypertensive patients (P<.05).
Key Points
- This research investigates how variations in blood pressure during the day relate to silent cerebrovascular damage in elderly hypertensive patients.
- Evaluated 131 elderly hypertensive patients using 24-hour ambulatory blood pressure monitoring and brain MRI.
- Classified patients into groups based on diurnal blood pressure patterns: nondippers (<10% reduction), dippers (10-20% reduction), and extreme dippers (≥20% reduction).
- Identified silent cerebrovascular damage through MRI findings of lacunae and hyperintense lesions.
- Silent cerebrovascular damage was significantly more common in patients with sustained hypertension compared to those with white coat hypertension.
- The dipper group showed the least extent of cerebrovascular damage compared to nondippers and extreme dippers (P < .05).
- Extreme dippers exhibited greater systolic pressure variability than dippers.
Study Design
Type
Observational (n=131)
Structured PICO
Do abnormal nocturnal blood pressure dipping patterns increase the risk of silent cerebrovascular damage in elderly asymptomatic hypertensive patients?
P
Population
131 elderly asymptomatic hypertensive patients
I
Intervention
Abnormal nocturnal blood pressure dipping patterns (nondippers: nocturnal reduction of systolic pressure <10%; extreme dippers: reduction ≥20%) assessed via 24-hour ambulatory blood pressure monitoring
C
Comparator
Normal dippers (nocturnal reduction of systolic pressure ≥10% to <20%)
O
Outcome
Silent cerebrovascular damage identified by brain magnetic resonance imaging (lacunae and advanced periventricular hyperintense lesions)surrogate
Both nondipping and extreme dipping of nocturnal blood pressure are associated with increased silent cerebrovascular damage in elderly hypertensive patients, forming a J-shaped relationship.
Main Result
p-value: p=<.05
Abstract
To study the relation between diurnal blood pressure variations and silent cerebrovascular damage, we performed both 24-hour ambulatory blood pressure monitoring and brain magnetic resonance imaging in 131 elderly asymptomatic hypertensive patients. Silent cerebrovascular damage was identified by the magnetic resonance imaging findings of lacunae (low intensity in T1-weighted images and high intensity in T2-weighted images) and advanced periventricular hyperintense lesions (on T2-weighted images). The frequency of silent cerebrovascular damage in the 100 patients with sustained hypertension was greater than that in the 31 patients with white coat hypertension. We further classified the former group into nondippers (nocturnal reduction of systolic pressure by or = 10% to or = 20%; n = 16). The extent of silent cerebrovascular damage was least severe in the dipper group (P < .05). This J-shaped relation was not found either with the cardiac hypertrophy detected by electrocardiography or with the renal damage assessed by urinary albumin excretion. More than half of the extreme dippers were patients with isolated systolic hypertension, and this prevalence was significantly greater than that in dippers or in nondippers (21% and 30%, respectively). Extreme dippers also had greater variability of pressure (standard deviation of awake systolic pressure) than dippers. Our results indicate that in addition to nondipping, extreme dipping (marked nocturnal fall of blood pressure) should be considered a type of abnormal diurnal blood pressure variation in elderly patients with hypertension who are likely to have advanced silent cerebrovascular damage.
Cite This Study
Kario et al. (1996) conducted an observational in Hypertension (n=131). Diurnal blood pressure variations (dipping status) vs. Dippers vs nondippers vs extreme dippers was evaluated on Silent cerebrovascular damage (lacunae and advanced periventricular hyperintense lesions on MRI) (p=<.05). Extreme dipping and nondipping of nocturnal blood pressure were associated with more severe silent cerebrovascular damage compared to normal dipping in elderly hypertensive patients (P<.05).