Cerebral microbleeds are associated with nocturnal reverse dipping in hypertensive patients with ischemic stroke
1 Seoul National University Boramae Hospital, Department of Neurology, College of Medicine, Seoul National University, Boramae-ro 5-gil 20, Dongjak-gu, Seoul 156-707, Republic of Korea
2 Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
3 Department of Cardiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
BMC Neurology 2014, 14:8 doi:10.1186/1471-2377-14-8Published: 12 January 2014
Abnormalities in nocturnal blood pressure dipping are well known for its relationship to cardiovascular diseases. Cerebral microbleeds are frequently observed in patients with hypertension and are known to be potent risk factors for stroke. However, there are scanty reports about the relationship between nocturnal dipping and cerebral microbleeds.
We recruited consecutive patients with both hypertension and ischemic stroke within 7 days after symptom onset, and those with cardioembolism were excluded. We applied 24-hour ambulatory blood pressure monitoring two weeks after stroke onset, and we used brain MRI to detect cerebral microbleeds. Various blood pressure parameters such as mean 24-hour blood pressure, awake/sleep blood pressure, and morning surge were compared between cerebral microbleeds (+) vs. (-) groups. Subjects were further classified according to nocturnal dipping status and were analyzed by logistic regression to determine its association with cerebral microbleeds with adjustment for age, gender, and cardiovascular risk factors.
A total of 162 patients (100 males, age 65.33 ± 10.32 years) were included. Cerebral microbleeds were detected in 65 patients (40.1%). Most ambulatory blood pressure parameters except morning surge were significantly higher in those who had cerebral microbleeds. After adjusting for the confounding factors, the reverse dippers were prone to have cerebral microbleeds (odds ratio, 3.81; 95% confidential interval, 1.36-10.65; p-value = 0.01).
Cerebral microbleeds are independently associated with reverse dipping on ambulatory blood pressure monitoring in hypertensive stroke patients.