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Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension
K Shimada1, A Kawamoto, K Matsubayashi
1Department of Medicine and Geriatrics, Kochi Medical School Hospital, Japan.
Insights
Elderly hypertensive patients who do not experience a nocturnal blood pressure dip show increased silent cerebrovascular damage. Maintaining a normal blood pressure fall overnight may prevent hypertensive vascular damage.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Neurology
Background:
- Hypertension in the elderly is a significant risk factor for cerebrovascular damage.
- Diurnal blood pressure variations, specifically the nocturnal dip, are crucial for cardiovascular health.
Purpose of the Study:
- To investigate the association between diurnal blood pressure changes and silent cerebrovascular damage in elderly hypertensive individuals.
- To determine if the absence of a nocturnal blood pressure fall (non-dipping) is linked to increased cerebrovascular damage.
Main Methods:
- Ambulatory blood pressure monitoring and brain MRI were performed on 54 hypertensive and 34 normotensive elderly subjects.
- Diurnal variation was defined as a systolic blood pressure difference ≥10 mmHg between awake and asleep periods.
- Silent cerebrovascular damage was assessed by identifying lacunae and periventricular hyperintensity.
Main Results:
- In hypertensive subjects, lacunae correlated more strongly with asleep systolic blood pressure.
- Non-dippers exhibited significantly higher grades of cerebrovascular damage and cardiac hypertrophy compared to dippers.
- No significant differences in age, awake blood pressure, blood viscosity, lipids, or sleep quantity were found between dippers and non-dippers.
Conclusions:
- Reduced or absent nocturnal blood pressure fall in elderly hypertensives is associated with silent cerebrovascular damage.
- A normal nocturnal blood pressure reduction may play a protective role against the development of hypertensive vascular damage.
Objective:
To examine the effect of diurnal blood pressure changes upon cerebrovascular damage in elderly patients with hypertension.
Design:
Fifty-four asymptomatic hypertensive and 34 normotensive elderly subjects underwent both 24-h non-invasive ambulatory blood pressure monitoring and brain magnetic resonance imaging. METHODS. Diurnal variation was defined as a difference of greater than or equal to 10 mmHg between mean awake and asleep systolic blood pressure. Hypertensives were thus classified as dippers or non-dippers. Low intense foci (lacunae) and advanced periventricular hyperintensity were identified as silent cerebrovascular damage.
Results:
In the hypertensive group, lacunae were correlated more closely with mean asleep systolic blood pressure than with mean awake systolic blood pressure. Age, awake blood pressure, predicted whole blood viscosity, lipid profiles or quantity of sleep did not differ between the hypertensive dippers or non-dippers. The non-dippers, however, showed significantly higher grades of cerebrovascular damage as well as cardiac hypertrophy by electrocardiography than the dippers, whose results were similar to those of normotensives in this regard.
Conclusions:
An absent or lower nocturnal blood pressure fall in elderly hypertensives is associated with silent cerebrovascular damage. In contrast, the presence of a nocturnal fall could prevent the development of hypertensive vascular damage.