Key result
Reverse-dipping blood pressure linked to ~2-fold higher prevalence of white matter hyperintensities vs. normal dipping.
Why the study?
The relationship between abnormal sleep blood pressure variations, such as non-dipping and reverse-dipping patterns, and cerebral small vessel disease markers was poorly established.
Does an abnormal circadian blood pressure pattern (non-dipping or reverse-dipping) increase the prevalence of silent cerebral small vessel disease compared to a normal dipping pattern?
Meta-Analysis (n=3,497)
Does an abnormal circadian blood pressure pattern (non-dipping or reverse-dipping) increase the prevalence of silent cerebral small vessel disease compared to a normal dipping pattern?
Abnormal circadian blood pressure patterns (especially reverse-dipping) are associated with subclinical cerebral small vessel disease, underscoring the clinical importance of monitoring and controlling nocturnal blood pressure.
Background Abnormal circadian blood pressure ( BP ) variations during sleep, specifically the non‐dipping (<10% fall in nocturnal BP ) and reverse‐dipping patterns (rise in nocturnal BP ), have been associated with an increased risk of cardiovascular events and target organ damage. However, the relationship between abnormal sleep BP variations and cerebral small vessel disease markers is poorly established. This study aims to assess the association between non‐dipping and reverse‐dipping BP patterns with markers of silent cerebral small vessel disease. Methods and Results MEDLINE , Embase, and Cochrane Databases were searched from inception through November 2019. Studies that reported the odds ratios (ORs) for cerebral small vessel disease markers in patients with non‐dipping or reverse‐dipping BP patterns were included. Effect estimates from the individual studies were extracted and combined using the random‐effect, generic inverse variance method of DerSimonian and Laird. Twelve observational studies composed of 3497 patients were included in this analysis. The reverse‐dipping compared with normal dipping BP pattern was associated with a higher prevalence of white matter hyperintensity with a pooled adjusted OR of 2.00 (95% CI , 1.13–2.37; I 2 =36%). Non‐dipping BP pattern compared with normal dipping BP pattern was associated with higher prevalence of white matter hyperintensity and asymptomatic lacunar infarction, with pooled OR s of 1.38 (95% CI , 0.95–2.02; I 2 =52%) and 2.33 (95% CI , 1.30–4.18; I 2 =73%), respectively. Limiting to only studies with confounder‐adjusted analysis resulted in a pooled OR of 1.38 (95% CI , 0.95–2.02; I 2 =52%) for white matter hyperintensity and 1.44 (95% CI , 0.97–2.13; I 2 =0%) for asymptomatic lacunar infarction. Conclusions The non‐dipping and reverse‐dipping BP patterns are associated with neuroimaging cerebral small vessel disease markers.
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Chokesuwattanaskul et al. (2020) conducted a meta-analysis in Silent cerebral small vessel disease (n=3,497). Reverse-dipping or non-dipping circadian blood pressure pattern vs. Normal dipping circadian blood pressure pattern was evaluated on Prevalence of white matter hyperintensity (reverse-dipping vs normal dipping) (OR 2.00, 95% CI 1.13-2.37). The reverse-dipping blood pressure pattern was significantly associated with a higher prevalence of white matter hyperintensity compared to a normal dipping pattern (OR 2.00, 95% CI 1.13-2.37).
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