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Changes of circadian blood pressure patterns are associated with the occurence of lucunar infarction
C Kukla1, D Sander, J Schwarze
1Department of Neurology, Technical University of Munich, Germany.
Insights
Reduced nighttime blood pressure decline is a key risk factor for lacunar infarction, alongside high blood pressure and age. This finding highlights the importance of monitoring circadian blood pressure patterns in stroke prevention.
Area of Science:
- Neurology
- Cardiology
- Hypertension Research
Background:
- Lacunar infarction is strongly linked to arterial hypertension.
- The role of circadian blood pressure changes in lacunar infarction pathogenesis is not well understood.
Purpose of the Study:
- To investigate the association between circadian blood pressure rhythm and the occurrence/extent of lacunar infarction.
Main Methods:
- Analyzed 24-hour ambulatory blood pressure monitoring and brain imaging in 118 patients (>55 years).
- Included 61 patients with lacunar infarction and 57 controls.
- Assessed daytime blood pressure variability and circadian blood pressure variation.
Main Results:
- Lacunar infarction patients were older, had higher hypertension rates, elevated daytime BP, and increased daytime BP variability.
- A blunted circadian blood pressure variation (reduced nighttime dip) was observed in patients with lacunar infarction.
- Logistic regression identified reduced systolic circadian variation, age, daytime BP, and hypertension history as significant predictors.
Conclusions:
- A reduced nighttime systolic blood pressure decline is a significant risk factor for lacunar infarction.
- Circadian blood pressure patterns are crucial in lacunar infarction development, beyond absolute BP levels and age.
Background:
The occurrence of lacunar infarction is closely related to arterial hypertension. However, there is only limited and partly controversial knowledge regarding the possible pathogenetic role of circadian blood pressure changes.
Objective:
To evaluate the relationship between circadian blood pressure rhythm, occurrence, and extent of lacunar infarction.
Methods:
We analyzed circadian blood pressure patterns, other cardiovascular risk factors, and occurrence of lacunar infarction in 118 hospitalized patients older than 55 years. Noninvasive 24-hour blood pressure measurements and magnetic resonance or computed tomographic brain imaging were performed in 61 patients with lacunar infarction and in 57 control patients. Daytime blood pressure variability was defined as the within-subject SD of all systolic and diastolic blood pressure readings during the daytime measurement period. Circadian blood pressure variation was defined as the average percentage change of nighttime blood pressure values compared with the daytime blood pressure values.
Results:
Patients with lacunar infarction were significantly older and showed more often a history of arterial hypertension, elevated average daytime blood pressure values, an increased systolic daytime blood pressure variability, and a reduced circadian blood pressure variation due to an increased incidence of a pathologic nighttime blood pressure increase. No significant correlation was found between these parameters and the number of lacunae. A logistic regression analysis revealed that a reduced systolic circadian blood pressure variation, age, systolic average daytime blood pressure, and a history of arterial hypertension were best correlated with the occurrence of lacunar infarction.
Conclusion:
Reduced nighttime decline in systolic blood pressure may be an important risk factor for the development of lacunar infarction in addition to the absolute level of blood pressure and age.