Tsivgoulis Georgios, Vemmos Konstantinos N, Zakopoulos Nikolaos, Spengos Konstantinos, Manios Efstathios, Sofia Vassilopoulou, Zis Vassilios, Mavrikakis Myron
Department of Neurology, University of Athens Medical School, Eginition Hospital, Athens, Greece.
Blood Press Monit. 2005 Aug;10(4):189-95. doi: 10.1097/01.mbp.0000172706.51792.04.
Nondipping pattern of nocturnal blood pressure is associated with silent ischemic cerebrovascular lesions and lacunar infarctions. In this case-control study, we aimed to evaluate the association of diurnal blood pressure variation with the occurrence of intracerebral hemorrhage.
Ambulatory blood pressure monitoring was performed at 21-28 days after ictus in 78 first-ever unselective consecutive patients with intracerebral hemorrhage and in 80 age-adjusted and sex-adjusted controls who were referred to the hypertension center of our institution. The degree of nocturnal blood pressure dip was calculated as [(mean daytime values-mean night-time values)/mean daytime values]x100. Nondippers were defined as patients who exhibited a <10% nocturnal dip in systolic blood pressure. Logistic regression models were constructed to assess the association of nondipping status with intracerebral hemorrhage after adjusting for potential confounders (cardiovascular risk factors, office and ambulatory blood pressure levels).
Prevalence of nondipping was significantly greater among cases than among controls (74.4% vs. 43.8%, P<0.001). Nondipping status was independently (P=0.033) associated with intracerebral hemorrhage (OR: 2.326, 95% CI: 1.068-5.050) in a multiple variable logistic regression model that adjusted for baseline characteristics, cardiovascular risk factors, office and ambulatory blood pressure variables. The magnitude of the nocturnal systolic blood pressure dipping was inversely related to the risk of intracerebral bleeding; the odds ratio for intracerebral hemorrhage associated with every 1% decrease in nocturnal systolic blood pressure dip was 1.143 (95% CI: 1.058-1.235, P=0.001).
Given the previous reports that nondipping contributes to the risk of cerebral infarction, our results indicate that blunted nocturnal blood pressure dip may be also associated with the occurrence of intracerebral hemorrhage.
夜间血压非勺型模式与无症状缺血性脑血管病变及腔隙性脑梗死相关。在这项病例对照研究中，我们旨在评估昼夜血压变化与脑出血发生之间的关联。
对78例首次发生的未经选择的连续性脑出血患者以及80例年龄和性别匹配的对照者（转诊至我院高血压中心）在发病后21 - 28天进行动态血压监测。夜间血压下降程度计算为[(白天平均血压值 - 夜间平均血压值)/白天平均血压值]×100。非勺型血压者定义为夜间收缩压下降幅度<10%的患者。构建逻辑回归模型，在调整潜在混杂因素（心血管危险因素、诊室血压和动态血压水平）后评估非勺型血压状态与脑出血的关联。
病例组中非勺型血压的患病率显著高于对照组（74.4%对43.8%，P<0.001）。在调整了基线特征、心血管危险因素、诊室血压和动态血压变量的多变量逻辑回归模型中，非勺型血压状态与脑出血独立相关（P = 0.033）（比值比：2.326，95%置信区间：1.068 - 5.050）。夜间收缩压下降幅度与脑出血风险呈负相关；夜间收缩压下降幅度每降低1%，脑出血的比值比为1.143（95%置信区间：1.058 - 1.235，P = 0.001）。
鉴于之前有报道称非勺型血压模式会增加脑梗死风险，我们的结果表明夜间血压下降减弱也可能与脑出血的发生有关。
