Abstract
BackgroundTo investigate the relationships between blood pressure (BP) circadian rhythms and acute cerebral infarction (ACI), silent cerebral infarction (SCI) and the severity of leukoaraiosis in hypertensive patients.MethodsA retrospective case-control study was performed among hypertensive patients with 24-h ambulatory blood pressure monitoring (ABPM) and cranial magnetic resonance imaging (MRI).ResultsA total of 1267 patients were enrolled. Lower nocturnal blood pressure (BP) decreases were observed in ACI patients than in controls (3.3% vs 8.2%, P<0.001). Reverse-dipper pattern (RD) and non-dipper pattern (ND) were found to be independent risk factors for ACI. In ACI patients, both RD and ND BP circadian rhythms were revealed to be independent risk factors for moderate-severe leukoaraiosis. In addition, in SCI patients, RD (OR = 1.7, 95% CI, 0.9–3.0; P = 0.047) or extreme-dipper pattern (ED) (OR = 2.9, 95% CI, 1.2–7.0; P = 0.015) were found to be independent risk factors for moderate-severe leukoaraiosis. Moreover, the greater the severity of leukoaraiosis was, the higher the ratio of abnormal BP circadian rhythms.ConclusionRD and ND BP circadian rhythms might not only be relevant to the onset of ACI but also correlate with the severity of leukoaraiosis. Thus, when modulating BP with antihypertensive drugs, the BP circadian rhythms, and not merely the BP level, should warrant more attention.
Highlights
To investigate the relationships between blood pressure (BP) circadian rhythms and acute cerebral infarction (ACI), silent cerebral infarction (SCI) and the severity of leukoaraiosis in hypertensive patients
We investigated the exact relevance of BP circadian rhythms to the onset of ACI and SCI and the severity of leukoaraiosis
The exclusion criteria were as follows: 1) Cardiogenic cerebral infarction; 2) Past stroke history; 3) Intracranial lesions such as bleeding or occupying lesions detected by cerebral CT or magnetic resonance imaging (MRI); 4) Having severe respiratory diseases, coronary heart diseases, malignant tumours, metabolic diseases such as severe liver and kidney dysfunction or thyroid dysfunction; and 5) Having contraindications for MRI, pregnancy or refusal to participate in the study
Summary
To investigate the relationships between blood pressure (BP) circadian rhythms and acute cerebral infarction (ACI), silent cerebral infarction (SCI) and the severity of leukoaraiosis in hypertensive patients. Previous studies have illustrated that hypertensive patients with the loss of blood pressure (BP) circadian rhythms might be more susceptible to cardio-cerebral vascular incidents. Physiological 24-h BP circadian rhythms play a vital role in protecting the structure and function of vessels. The loss or attenuation of rhythms might lead to impairments in endothelial function, inflammatory reactions [4] and oxidative stress activations [5] and further induced or aggravated atherosclerosis. An increasing number of studies have revealed a close relationship between BP circadian rhythm changes and cerebral small vessel diseases (CSVDs) [6,7,8]. CSVDs have doubled the hazard of stroke, resulting in approximately 20% of stroke
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