From the Department of Neurology, Kyoto Second Red Cross Hospital (Y.Y.,
K.O., M.H.), and the Department of Neurology, Kyoto University (Japan) (I.A.,
J.K.).
Correspondence to Yasumasa Yamamoto, MD, Department of Neurology, Kyoto Second Red Cross Hospital, 355–5 Haruobicho Kamigyoku, Kyoto 602, Japan.
Background and
Purpose—Antihypertensive therapy has dramatically reduced the
incidence of stroke recurrence; however, recent studies have
suggested that the excessive lowering of blood pressure (BP) could
cause ischemic cerebral lesions. We conducted a prospective
study using MRI and ambulatory blood pressure monitoring to elucidate
the appropriate BP control level for the prevention of silent and
symptomatic cerebral infarction.
Methods—We studied 105 patients with symptomatic
lacunar infarcts who underwent repeated MRI and 24-hour BP monitoring
in the period between the two MRI examinations. The patients were
divided into five groups according to their outcome as follows: group
1, those who showed neither symptomatic episodes nor the
development of new silent lesions detected by repeated MRI; group 2,
those who only showed the development of silent lacunae; group 3, those
who showed development of diffuse white matter lesions only; group 4,
those who showed the development of both silent lacunae and diffuse
white matter lesions; and group 5, those who showed
symptomatic cerebrovascular disease. Groups 2 through 5
were then compared with group 1 with respect to the ambulatory BP
values.
Results—The average follow-up period was 3.2±2.6 years
(mean±SD). In all patients in group 4 and group 5, nighttime
systolic BPs were significantly higher than in group 1 (both
P<.01), and the magnitude of the nocturnal
systolic BP dip and diastolic BP dip in group 4 and
group 5 were significantly smaller than in group 1 (all
P<.01). In patients who took antihypertensive agents,
the 24-hour systolic and diastolic BPs and
nighttime systolic and diastolic BPs in group 4
were significantly higher than in group 1 (P<.01,
P<.01, P<.001, P<.01,
respectively). The magnitude of the nocturnal systolic and
diastolic BP dip in group 5 was significantly smaller than
in group 1 (both P<.01).
Conclusions—A high average ambulatory BP, especially nighttime
BP, and a reduced nocturnal BP dip may have an adverse effect on the
development of silent ischemic lesions and
symptomatic stroke attack in patients with lacunar
infarcts.
© 1998 American Heart Association, Inc.
Original Contributions
Adverse Effect of Nighttime Blood Pressure on the Outcome of Lacunar Infarct Patients
Key Words: Binswanger's disease • blood pressure, nocturnal • lacunar infarction • white matter
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