Adverse Effect of Nighttime Blood Pressure on the Outcome of Lacunar Infarct Patients

Yamamoto, Yasumasa; Akiguchi, Ichiro; Oiwa, Kaiyo; Hayashi, Masamichi; Kimura, Jun

doi:10.1161/01.str.29.3.570

Cited by 140 publications

(115 citation statements)

References 55 publications

(55 reference statements)

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“…A diminished nocturnal BP dip may protect against end-organ damage caused by decreased blood flow during sleep, 20 which supports our study result that SAS patients with severe CKD tended to have BP elevation.…”

Section: Influential Factors In Circadian Bp Changessupporting

confidence: 87%

Relationship between chronic kidney disease and sleep blood pressure in patients with sleep apnea syndrome

et al. 2010

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Chronic kidney disease (CKD) is common disease in patients with sleep apnea syndrome (SAS), which is considered to be responsible for secondary and nocturnal hypertension. In this study, we assessed blood pressure (BP) changes in SAS patients with CKD. Of 460 Japanese outpatients with suspected SAS who underwent ambulatory BP monitoring within 3 months of overnight polysomnography, 198 patients (172 males and 26 females) who were not receiving treatment with antihypertensives or nitroglycerin were enrolled. The estimated glomerular filtration rate (eGFR) was calculated, and the patients were stratified into the high (H; eGFRX60 ml min À1 per 1.73 m 2 ) or the low (L; eGFRo60 ml min À1 per 1.73 m 2 ) group. The patients in the L group were significantly older than those in the H group (Po0.001), and body mass index was significantly smaller in the L group than in the H group (P¼0.025). The rate of patients treated with statin (P¼0.030) and the levels of both triglyceride (P¼0.006) and creatinine (Po0.001) differed significantly between the two groups. The sleep data, 24-h BP, awake BP and morning BP showed no significant differences between the two groups. However, sleep systolic and diastolic BPs were significantly higher in the L group (122.5±16.7 mm Hg and 81.1±12.2 mm Hg, respectively) than in the H group (117.1±11.8 mm Hg, P¼0.033; and 76.1±9.5 mm Hg, P¼0.012, respectively). SAS patients with CKD had elevated sleep BP. This result suggests that appropriate treatments for both SAS and CKD prevent sleep BP elevation, which is considered a risk factor for the onset risk of a cardiovascular event. Keywords: ambulatory blood pressure monitoring; circadian blood pressure; estimated glomerular filtration rate; nocturnal hypertension; polysomnography INTRODUCTIONIt is important to consider blood pressure (BP) outside of a clinic setting when treating patients with hypertension, because BP measurements obtained in a clinic setting are not representative of BP outside of the clinic setting. Abnormal changes in circadian BP are considered to increase the risk of cardiovascular event. Patients with nocturnal hypertension or a morning BP surge tend to have a higher incidence of silent cerebrovascular disease 1 and greater intima-media and relative wall thickness compared with normotensive patients. 2 Nocturnal hypertension and morning BP surge are induced by sleep disordered breathing, which can be observed in 22% of Japanese adult males. 3 Typical clinical features of BP changes in patients with sleep disordered breathing and those with sleep apnea syndrome (SAS) are nocturnal hypertension and non-dipper patterns of circadian BP. As the severity of SAS increases, sleep BP is elevated even in a patient whose BP is within the normal range in the clinic. Moreover, the incidence of nocturnal cardiovascular events while sleeping increases in these patients. [4][5][6] Chronic kidney disease (CKD) seems to be tightly linked with nocturnal hypertension and morning BP surge. 7 CKD poses a high risk for the onset of cardiovascu...

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Section: Influential Factors In Circadian Bp Changessupporting

confidence: 87%

Relationship between chronic kidney disease and sleep blood pressure in patients with sleep apnea syndrome

et al. 2010

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“…Although there is evidence that raised BP levels in the acute phase of stroke are associated with a poor prognosis, [2][3][4] other work suggests that BP has little prognostic value 5,6 or even that constantly high BP may indicate good prognosis. 7 There is a possibility of a J-shaped relationship between BP and stroke outcome, with poorer outcome in the groups with extreme BP.…”

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confidence: 99%

Effect of Blood Pressure During the Acute Period of Ischemic Stroke on Stroke Outcome

Aslanyan

Fazekas

Weir

et al. 2003

Stroke

136

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Background and Purpose-The effects of blood pressure (BP) and its fluctuations during the acute phase on the clinical course of ischemic stroke are incompletely understood. We tested the hypotheses that baseline mean arterial BP [MAPϭ(2ϫdiastolic BPϩsystolic BP)/3], weighted average MAP, and an increase or decrease of Ͼ30% from baseline MAP are independently associated with stroke outcome. Methods-We studied the 1455 patients with ischemic stroke in the Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International Trial. BP management was at the discretion of investigators and was measured at 0, 0.5, 4, 12, 12.25, 60, and 60.25 hours. Outcome was assessed by mortality, Barthel Index (dead or 0 to 55 versus 60 to 90 versus Ն95), National Institutes of Health Stroke Scale (NIHSS) score (dead or Ն2), and Rankin Scale (dead or Ն2). Cox proportional-hazards and stepwise logistic regression modeling corrected for demography, medical history, stroke severity, and clinical subtype.

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“…This could be especially important in subjects who have suffered a stroke, in which cerebral autoregulation, responsible for maintaining cerebral blood flow constant over a wide range of BP, is often dysfunctional, causing cerebral perfusion to become more dependent on BP values. 26 However, Yamamoto et al 27 did not observe the J-curve phenomenon or an excessive fall in the nighttime BP leading to cerebral ischemic lesions in a prospective study of 105 patients with symptomatic lacunar infarcts who underwent repeated magnetic resonance imaging and 24-hour BP monitoring with an average follow-up period of 3.2 years in order to elucidate the appropriate BP control level for prevention of silent and symptomatic cerebral infarction. Nevertheless, the authors pointed out that the fact that patient BP was controlled at relatively high levels in the study, and that they restricted their subjects to patients with lacunar infarcts may have contributed to the lack of a J-curve.…”

Section: Abpm and The J Curve After Strokementioning

confidence: 98%

Chronic Management of Hypertension after Stroke: The Role of Ambulatory Blood Pressure Monitoring

Castilla-Guerra

Fernández-Moreno

2015

J Stroke

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The authors have no financial conflicts of interest.Hypertension is the most important potentially reversible risk factor for stroke in all age groups; high blood pressure (BP) is also associated with increased risk of recurrent stroke in patients who have already had an ischemic or hemorrhagic event. Twenty-four hour ambulatory BP monitoring (ABPM) has become an important tool for improving the diagnosis and management of hypertension, and is increasingly used to assess patients with hypertension. Nevertheless, although ABPM devices are increasingly used for assessment of hypertension, their value in the chronic management of hypertension in patients with stroke has not been systematically studied. In fact, among large-scale randomized trials for secondary stroke prevention, only the Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention trial included 24-hour ABPM. ABPM has demonstrated chronic disruption of the circadian rhythm of BP after acute phase of stroke and has shown higher sensitivity compared to office BP in evaluating the effectiveness of antihypertensive treatment among stroke survivors. High 24-hour BP is an independent predictor for cerebrovascular events, brain microbleeds, and subsequent development of dementia. Nevertheless, although stroke care guidelines endorse the importance of hypertension management, the specific role of ABPM among stroke survivors after the acute phase of disease has not been established. Further studies are needed to clarify whether routine application of ABPM among these patients should be recommended.

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Adverse Effect of Nighttime Blood Pressure on the Outcome of Lacunar Infarct Patients

Cited by 140 publications

References 55 publications

Relationship between chronic kidney disease and sleep blood pressure in patients with sleep apnea syndrome

Relationship between chronic kidney disease and sleep blood pressure in patients with sleep apnea syndrome

Effect of Blood Pressure During the Acute Period of Ischemic Stroke on Stroke Outcome

Chronic Management of Hypertension after Stroke: The Role of Ambulatory Blood Pressure Monitoring

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