Abstract
Background and Purpose: Nocturnal non-dipping blood pressure and heart rate are associated with an increased risk of cardiovascular disease. The effects of such variance on cerebrovascular disease have not been well studied.Methods: The 24-h ambulatory blood pressure (ABPM) and heart rate were monitored with B-pro in patients with acute stroke within the initial week of hospital admission. The risk factor profiles, clinical presentation, imaging, and short-term prognosis were compared in nocturnal dippers and non-dippers (more than 10% nocturnal decrease) of blood pressure and heart rate.Results: We enrolled 234 patients in whom ABPM and MRI data were available. Heart rate data were available in 180 patients. Lacunar sub-cortical stroke was the most common acute lesion (58.9%), while hypertension (74%) and diabetes (41.5%) were the most common associated risk factors. ABPM revealed non-dipping in 69% of patients. On univariate analysis, Small Vessel Disease (SVD) was significantly more frequent in non-dippers vs. dippers (BP: 56.8 vs. 40.3% p = 0.02; heart rate: 57.9 vs. 40.7% p = 0.03). Silent strokes were also more frequent in non-dippers vs. dippers (BP: 40.7 vs. 26.4% p = 0.35; heart rate: 44.6 vs. 25.4% p = 0.01). Multivariate analysis revealed SVD to be significantly related to age, hypertension, blood pressure non-dipping, and severity of symptoms at index event.Conclusions: The presence of nocturnal non-dipping of blood pressure and heart rate are associated with an increased risk of silent stroke and SVD. Increased use of ABPM may allow for improved diagnosis of non-dippers.
Highlights
In 1988 O’Brian et al reported in a study of 102 hypertensive patients that non-dippers (17% of enrolled subjects) were at a higher risk of stroke during follow-up [1]
The “non-dipping” and “reverse dipping” patterns may result in a higher 24-h mean blood pressure level leading to greater pressure load and shear stress on vessels resulting in accelerated atherosclerosis [4, 6]
We report on the effects of nocturnal nondipping of blood pressure and heart rate on the frequency of small vessel disease (SVD) in acute stroke patients
Summary
In 1988 O’Brian et al reported in a study of 102 hypertensive patients that non-dippers (17% of enrolled subjects) were at a higher risk of stroke during follow-up [1]. Subsequent studies have shown a strong association between of the incidence of atherosclerosis, coronary artery disease (CAD), and stroke in non-dippers [2,3,4]. Similar to changes in nocturnal blood pressure, non-dipping in the heart rate during sleep is associated with an increased risk of heart disease and increased mortality [7,8,9,10]. Nocturnal non-dipping blood pressure and heart rate are associated with an increased risk of cardiovascular disease. The effects of such variance on cerebrovascular disease have not been well studied
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