The association of blunted nocturnal blood pressure dip and stroke in a multiethnic population

Abstract

Nondipping has been defined as a reduction in the mean systolic and diastolic blood pressure (BP) of <10% from awake to sleep. We hypothesized that nondipping might be associated with stroke in minority populations. We monitored BP over a 24 h period with an ambulatory device in 166 cases from a multiethnic population of stroke survivors (63 blacks, 61 non-Hispanic whites, and 42 Caribbean Hispanics, aged 69.5 +/- 11 years) and 217 community control subjects (73 blacks, 107 non-Hispanic whites, and 67 Caribbean Hispanics, aged 69 +/- 9 years). Prevalence of nondipping was significantly greater among cases than among control subjects (64% v. 37%, P < .001). In a multiple logistic regression model adjusted for traditional risk factors for stroke, nondipping conferred an increased risk for stroke. Probability of stroke associated with nondipping (odds ratio (OR) 2.5, confidence interval (CI) 1.6 to 4.0) was equal to that of traditional risk factors. Nondipping increased the chance of having a stroke in both non-Hispanic whites (OR 4.2, P < .001) and blacks/Caribbean Hispanics (OR 1.9, P = .03). The strength of the contribution of nondipping to stroke risk was similar in all ethnic groups. Nondipping was associated with stroke in both men and women. Given the previous reports that nondipping contributes to stroke risk in European and Asian populations, these data suggest that nondipping may be universally associated with risk for stroke.

Association of blunted nocturnal blood pressure dip with intracerebral hemorrhage

“…Our results corroborate the findings of several crosssectional and prospective studies that have reported more extensive clinical and subclinical target organ damage in the heart, brain and kidneys of nondippers than in dippers [3][4][5][6][7][8][9][10][11][12][13]. They are in line with the hypothesis that target organ damage and prognosis are worse when the BP load is persistent throughout the 24 h than when it is limited to the daytime hours [1,2].…”

“…Moreover a nondipping status, that is, a state whereby patients exhibit either an absence of or a reduced nocturnal BP dip, was reported to correlate with more advanced target organ damage (left ventricular hypertrophy, microalbuminuria, progression of renal damage) [3][4][5][6] and to be an independent predictor of cardiovascular mortality [7]. Accordingly, numerous case-control studies have indicated an independent association between a blunted or an abolished nocturnal BP dip and silent cerebrovascular lesions [8], lacunar infarction [9] and stroke [10,11]. Furthermore, abnormal dipping patterns of nocturnal BP have been prospectively related to the incidence of subsequent, symptomatic cerebrovascular events both in hypertensive individuals [12] and in stroke patients [13].…”

Circadian blood pressure and heart rate characteristics in haemorrhagic vs ischaemic stroke in Chinese people

“…Several other cross-sectional and prospective studies as well have reported extensive clinical and subclinical target organ damage in the heart, brain and kidneys in association with BP variability. 20,[23][24][25] The above-cited studies relied on the DNR for a classification by 'dipping'. But Cornélissen et al 26,27 showed that circadian characteristics derived by cosinor, such as the 24-h amplitude and acrophase, interpreted in the light of time-specified reference values qualified by gender and age, 7,8,28 were more sensitive than the DNR to recognize early cardiovascular disease risk.…”

"Monitorização ambulatorial da pressão arterial de pacientes com oclusão do ramo da veia central da retina"

“…Pacientes com oclusões venosas têm um risco significativamente maior de desenvolverem doença cardiovascular (Martin et al, 2002), doença da artéria carótida (Wong et al, 2005) e acidente vascular cerebral (Tsaloumas et al, 2000), de maneira semelhante pacientes com ausência de descenso da pressão arterial têm uma maior incidência de lesões encefálicas (Shimada e Kazuomi, 1997;Phillips et al, 2000), renais (Bianchi et al, 1997;Csiky et al, 1999), hipertrofia ventricular esquerda (Verdecchia et al, 1990) e risco de eventos cardiovasculares (Verdecchia et al, 1994).…”

“…Vários estudos demonstraram a importância prognóstica da falta de queda da pressão arterial durante o sono, correlacionando este fato com uma maior incidência de lesões encefálicas (Shimada e Kazuomi, 1997;Phillips et al, 2000), renais (Bianchi et al, 1997;Csiky et al, 1999), hipertrofia ventricular esquerda (Verdecchia et al, 1990, Morfis et al, 2002 e risco de eventos cardiovasculares (Verdecchia et al, 1994).…”