Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives

Kario, Kazuomi; Pickering, Thomas G.; Matsuo, Takefumi; Hoshide, Satoshi; Schwartz, Joseph E.; Shimada, Kazuyuki

doi:10.1161/hy1001.092640

Cited by 686 publications

(603 citation statements)

References 18 publications

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“…Individuals with a non-dipper pattern (reduction in nighttime SBP o10%) are at increased risk for cerebrovascular and cardiovascular complications Nocturnal dipping and endothelial function in resistant hypertension T Quinaglia et al when compared with individuals with a normal dipper profile. 16,[21][22][23][24][25][26] Previous studies have shown that patients with UCRH and CRH both have blunted nocturnal drops in SBP and DBP. 3,27 In these earlier publications, patients with RHTN have a high prevalence of nondipper pattern which contributes to an increased risk of cardiovascular events, 18 as well as a high prevalence of target organ damage at cardiac, macroand microvascular levels.…”

Section: Discussionmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9 ± 1.7%; DBP, 7.5 ± 1.8 versus 10.9 ± 1.8%, UCRH and CRH, respectively; Po0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9 ± 2.3% versus 7.1 ± 5.1%; Po0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

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Section: Discussionmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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“…Our previous data indicated that among older hypertensive patients (n¼575, mean age 72 years), subjects with reverse dipping (n¼63, 11%) had the highest incidence of stroke (22% during 41 months of follow-up), in particular fatal type stroke ( Figure 3) and hemorrhagic stroke; the incidence of hemorrhagic stroke was more prominent in the reverse dipping group (29% of stroke events) than in other dipping groups (7.7% of stroke events, P¼0.04). 31 The patient characteristics associated with reverse dipping are older, male and lean. In another study of treated older hypertensive patients (mean age, 76 years; n¼148), blunted nocturnal BP dipping was associated with poor physical function and cognitive dysfunction.…”

Section: Nocturnal Bp Dipping and Cardiovascular Riskmentioning

confidence: 99%

“…27,31,[33][34][35] Extreme dipping is a complex phenomenon. Contrary to the established notion that subjects with low nocturnal BP are at low cardiovascular risk, extreme dippers have a higher prevalence of silent cerebral infarction, deep white matter lesions and silent myocardial ischemia during sleep than dippers.…”

Section: Nocturnal Blood Pressure and Cardiovascular Risk Y Yano And mentioning

confidence: 99%

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

2012

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The accurate measurement, prediction and treatment of high blood pressure (BP) are essential issues in the management of hypertension. Ambulatory blood pressure monitoring (ABPM) has been shown to be superior to clinic BP measurements as ABPM can provide the following important information: (i) the mean BP levels, (ii) the diurnal variation in BP and (iii) the short-term BP variability. Among these parameters, there is increasing evidence that the mean nocturnal BP level is the most sensitive predictor of cardiovascular morbidity and mortality. Furthermore, several studies have shown that less nocturnal BP dipping, defined as less nocturnal BP decline relative to daytime BP, or a high night-day BP ratio was associated with poor prognosis irrespective of the 24-hour BP levels. These findings can be interpreted in at least two ways: namely, high nocturnal BP or less nocturnal BP dipping might be not only a potent risk factor for cardiovascular disease (CVD), but also a marker of pre-existing or concurrent diseases that can lead to nocturnal BP elevation. In this review, we consider the clinical utility of ABPM and in particular focus on the nocturnal BP levels or nocturnal BP dipping as a potent risk factor for CVD. In addition, the clinical management of high nocturnal BP and blunted nocturnal BP dipping with antihypertensive medications is discussed.

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“…Non‐dippers and extreme dippers are defined as those with a night‐time BP reduction of <10 or >20% of daytime BP, respectively. Risers have night‐time BP levels that are higher than daytime levels5, 6.…”

Section: Methodsmentioning

confidence: 99%

Blood pressure circadian rhythms and adverse outcomes in type 2 diabetes patients diagnosed with orthostatic hypotension

Chang

Hou

et al. 2017

J of Diabetes Invest

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Aims/IntroductionPatients with diabetes frequently develop orthostatic hypotension (OH). The present study was designed to examine the relationship of blood pressure (BP) circadian rhythms and outcomes in diabetes with OH.Materials and MethodsIn the present study, 173 inpatients with type 2 diabetes were enrolled. Patients were divided into an OH group and a non‐OH group according to the BP changes detected in the supine and standing position. Then, 24‐h ambulatory BP was monitored. Patients were followed up for an average of 45 ± 10 months post‐discharge. Outcomes – death and major adverse cardiac and cerebrovascular events, including heart failure, myocardial infarction and stroke – were recorded.ResultsThere were 61 patients (35.26%) in the OH group and 112 patients (64.74%) in the non‐OH group. In the OH group, the night‐time systolic BP and night‐time diastolic BP were higher, the blood BP rhythms were predominantly of the riser type (67.21%). OH was as an independent marker of riser type circadian rhythm (adjusted odds ratio 4.532, 95% confidence interval 2.579–7.966). In the OH group, the incidence rates of mortality, and major adverse cardiac and cerebrovascular events were increased significantly compared with those in the non‐OH group (11.48 vs 2.68%, P = 0.014; 37.70 vs 8.93%, P < 0.01).ConclusionsIn patients who had type 2 diabetes diagnosed with OH, the BP circadian rhythm usually showed riser patterns, and they had increased rates of mortality, and major adverse cardiac and cerebrovascular events.

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Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives

Cited by 686 publications

References 18 publications

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

Blood pressure circadian rhythms and adverse outcomes in type 2 diabetes patients diagnosed with orthostatic hypotension

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