Night-time systolic blood pressure and subclinical cerebrovascular disease: the Cardiovascular Abnormalities and Brain Lesions (CABL) study

Koki Nakanishi, Zhezhen Jin, Shunichi Homma, Mitchell S.V. Elkind, Tatjana Rundek, Joseph E. Schwartz, Tetz C. Lee, Aylin Tugcu, Mitsuhiro Yoshita, Charles DeCarli, Clinton B. Wright, Ralph L. Sacco, Marco R. Di Tullio

Research output: Contribution to journalArticle

Abstract

AIMS: Although ambulatory blood pressure (BP) is a better predictor of cardiovascular outcomes than office BP, its association with subclinical cerebrovascular disease is not clarified. We investigated the associations of office and ambulatory BP values with subclinical cerebrovascular disease in a population based, predominantly elderly cohort without prior stroke. METHODS AND RESULTS: Eight hundred and twenty-eight participants underwent 24-h ambulatory BP monitoring (ABPM), 2D echocardiography and brain magnetic resonance imaging in the Cardiac Abnormalities and Brain Lesion (CABL) study. Daytime, night-time, and 24-h BPs, nocturnal dipping pattern, morning surge (MS), and 24-h variability were assessed. Subclinical cerebrovascular disease was defined as silent brain infarcts (SBIs) and white matter hyperintensity volume (WMHV). The association of BP measures with the presence of SBI and upper quartile of log-WMHV (log-WMHV4) was analysed. SBIs were detected in 111 patients (13.4%). Mean log-WMHV was -0.99 ± 0.94. In multivariable analysis, only night-time systolic BP (SBP) was significantly associated with SBI [odds ratio (OR) 1.15 per 10 mmHg, P = 0.042], independent of cardiovascular risk factors, and pertinent echocardiographic parameters. Although daytime, night-time, 24-h BPs, and non-dipping pattern were all significantly associated with log-WMHV4 (all P < 0.05), night-time SBP showed the strongest association (OR 1.21 per 10 mmHg, P = 0.003) and was the sole independent predictor when tested against the other BP parameters. Office BP measures, MS, and BP variability were not associated with subclinical cerebrovascular disease in adjusted analyses. CONCLUSION: Elevated night-time SBP is strongly associated with subclinical cerebrovascular disease. Night-time SBP by ABPM allows to identify individuals at higher risk of hypertensive brain injury.

Original languageEnglish (US)
Pages (from-to)765-771
Number of pages7
JournalEuropean heart journal cardiovascular Imaging
Volume20
Issue number7
DOIs
StatePublished - Jul 1 2019

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Cardiovascular Abnormalities
Cerebrovascular Disorders
Blood Pressure
Brain
Odds Ratio
Ambulatory Monitoring
Ambulatory Blood Pressure Monitoring
Brain Injuries
Echocardiography
Stroke
Magnetic Resonance Imaging

Keywords

  • ambulatory blood pressure monitoring
  • night-time blood pressure
  • silent brain infarcts
  • white matter hyperintensity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Night-time systolic blood pressure and subclinical cerebrovascular disease : the Cardiovascular Abnormalities and Brain Lesions (CABL) study. / Nakanishi, Koki; Jin, Zhezhen; Homma, Shunichi; Elkind, Mitchell S.V.; Rundek, Tatjana; Schwartz, Joseph E.; Lee, Tetz C.; Tugcu, Aylin; Yoshita, Mitsuhiro; DeCarli, Charles; Wright, Clinton B.; Sacco, Ralph L.; Di Tullio, Marco R.

In: European heart journal cardiovascular Imaging, Vol. 20, No. 7, 01.07.2019, p. 765-771.

Research output: Contribution to journalArticle

Nakanishi, K, Jin, Z, Homma, S, Elkind, MSV, Rundek, T, Schwartz, JE, Lee, TC, Tugcu, A, Yoshita, M, DeCarli, C, Wright, CB, Sacco, RL & Di Tullio, MR 2019, 'Night-time systolic blood pressure and subclinical cerebrovascular disease: the Cardiovascular Abnormalities and Brain Lesions (CABL) study', European heart journal cardiovascular Imaging, vol. 20, no. 7, pp. 765-771. https://doi.org/10.1093/ehjci/jey221
Nakanishi, Koki ; Jin, Zhezhen ; Homma, Shunichi ; Elkind, Mitchell S.V. ; Rundek, Tatjana ; Schwartz, Joseph E. ; Lee, Tetz C. ; Tugcu, Aylin ; Yoshita, Mitsuhiro ; DeCarli, Charles ; Wright, Clinton B. ; Sacco, Ralph L. ; Di Tullio, Marco R. / Night-time systolic blood pressure and subclinical cerebrovascular disease : the Cardiovascular Abnormalities and Brain Lesions (CABL) study. In: European heart journal cardiovascular Imaging. 2019 ; Vol. 20, No. 7. pp. 765-771.
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AU - Nakanishi, Koki

AU - Jin, Zhezhen

AU - Homma, Shunichi

AU - Elkind, Mitchell S.V.

AU - Rundek, Tatjana

AU - Schwartz, Joseph E.

AU - Lee, Tetz C.

AU - Tugcu, Aylin

AU - Yoshita, Mitsuhiro

AU - DeCarli, Charles

AU - Wright, Clinton B.

AU - Sacco, Ralph L.

AU - Di Tullio, Marco R.

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N2 - AIMS: Although ambulatory blood pressure (BP) is a better predictor of cardiovascular outcomes than office BP, its association with subclinical cerebrovascular disease is not clarified. We investigated the associations of office and ambulatory BP values with subclinical cerebrovascular disease in a population based, predominantly elderly cohort without prior stroke. METHODS AND RESULTS: Eight hundred and twenty-eight participants underwent 24-h ambulatory BP monitoring (ABPM), 2D echocardiography and brain magnetic resonance imaging in the Cardiac Abnormalities and Brain Lesion (CABL) study. Daytime, night-time, and 24-h BPs, nocturnal dipping pattern, morning surge (MS), and 24-h variability were assessed. Subclinical cerebrovascular disease was defined as silent brain infarcts (SBIs) and white matter hyperintensity volume (WMHV). The association of BP measures with the presence of SBI and upper quartile of log-WMHV (log-WMHV4) was analysed. SBIs were detected in 111 patients (13.4%). Mean log-WMHV was -0.99 ± 0.94. In multivariable analysis, only night-time systolic BP (SBP) was significantly associated with SBI [odds ratio (OR) 1.15 per 10 mmHg, P = 0.042], independent of cardiovascular risk factors, and pertinent echocardiographic parameters. Although daytime, night-time, 24-h BPs, and non-dipping pattern were all significantly associated with log-WMHV4 (all P < 0.05), night-time SBP showed the strongest association (OR 1.21 per 10 mmHg, P = 0.003) and was the sole independent predictor when tested against the other BP parameters. Office BP measures, MS, and BP variability were not associated with subclinical cerebrovascular disease in adjusted analyses. CONCLUSION: Elevated night-time SBP is strongly associated with subclinical cerebrovascular disease. Night-time SBP by ABPM allows to identify individuals at higher risk of hypertensive brain injury.

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