Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives

摘要: It remains uncertain whether abnormal dipping patterns of nocturnal blood pressure influence the prognosis for stroke. We studied stroke events in 575 older Japanese patients with sustained hypertension determined by ambulatory monitoring (without medication). They were subclassified their systolic fall (97 extreme-dippers, >/=20% fall; 230 dippers, >/=10% but /=0% <10% and 63 reverse-dippers, <0% fall) followed prospectively an average duration 41 months. Baseline brain magnetic resonance imaging (MRI) disclosed that percentages multiple silent cerebral infarct 53% 29% 41% nondippers, 49% reverse-dippers. There was a J-shaped relationship between status incidence (extreme-dippers, 12%; 6.1%; 7.6%; 22%), this remained significant Cox regression analysis after controlling age, gender, body mass index, 24-hour pressure, antihypertensive medication. Intracranial hemorrhage more common reverse-dippers (29% strokes) than other subgroups (7.7% strokes, P=0.04). In extreme-dipper group, 27% strokes ischemic occurred during sleep (versus 8.6% 3 subgroups, P=0.11). conclusion, hypertensive patients, extreme may be related to clinical ischemia through hypoperfusion or exaggerated morning rise whereas reverse pose risk intracranial hemorrhage.