Abnormal blood pressure circadian rhythms are relevant to cerebral infarction and Leukoaraiosis in hypertensive patients

Abstract

Background: 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. Methods: A retrospective case-control study was performed among hypertensive patients with 24-h ambulatory blood pressure monitoring (ABPM) and cranial magnetic resonance imaging (MRI). Results: A 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. Conclusion: RD 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.

Higher Burden of Cerebral Small Vascular Disease Predicts Major Adverse Cardiac and Cerebrovascular Events and Is Related to Abnormal Blood Pressure Variability Pattern in Hypertension Patients

“…A recent study based on the Rotterdam study demonstrated that increased visit-to-visit BPV led to subclinical brain microstructure alterations including CSVD (Ma et al, 2020). In contrast, our previous study found that abnormal blood pressure circadian rhythms correlated with cerebral infarction and leukoaraiosis (Yang et al, 2020). However, how abnormal BPV promotes cerebral structure remains to be clarified (Iadecola and Parikh, 2020).…”

“…Categorical data were expressed as frequencies and percentages and were compared using chi-square tests or Fisher’s exact tests, when appropriate. Variables with P < 0.1 and variables relevant to our research (lacunes, EPVS, brain atrophy, WMH, cSS, and BPV subtype) ( Yang et al, 2020 ; Xu et al, 2021 ) were included in a subsequent multivariate logistic regression to identify independent predictors. When exploring predictors for MACCE, each CSVD marker and total CSVD marker numbers were included in two distinct models to avoid collinearity because they were mutually closely correlated.…”

“…Among them, the reverse-dipper pattern is proven to be associated with lacunar infarction (Yan et al, 2015). Our previous study has also shown that reverse-dipper and non-dipper patterns predict leukoaraiosis (Yang et al, 2020). However, most of the previous studies focused on one or two markers of CSVD, and less attention was paid to the total burden of CSVD.…”

Korelasi Derajat Leukoaraiosis dengan Faktor-faktor Risiko Stroke dan Keparahan Stroke Berdasarkan Derajat Klinis pada Pasien Stroke Iskemik

“…Pasien hipertensi, terutama pasien hipertensi kronis, terjadi penebalan dinding bagian dalam dan degenerasi hialin pada arteriol intrakranial dan arteri perforasi dalam. Karena kurangnya arteri perforasi dalam dan sirkulasi kolateral, materi putih terluka, dan kemudian terjadi leukoaraiosis (Yang et al, 2020). Hipertensi sangat terkait dengan penyakit materi putih dan mungkin merupakan faktor risiko paling penting yang dapat dimodifikasi.…”

The Regulation of miR-206 on BDNF: A Motor Function Restoration Mechanism Research on Cerebral Ischemia Rats by Meridian Massage

“…Cerebral infarction, a common disease affecting the nervous system, has evolved into the top three lethal diseases causing mortality [ 1 ]. Despite the risk of stroke dropping by 25% till 2010 as medical technologies and methods advanced, the rate of disability remains on the rise even over 80%, struck by sequelae, namely, motor, sensory, and cognitive disorders, which become a heavy burden carried upon the shoulders of patients, their families, and society [ 2 , 3 ].…”