Shen Yu, Xiang Wenwen, Chen Shenjian, Hou Zhou, Hong Daojun
Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People's Republic of China.
Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People's Republic of China.
Int J Gen Med. 2025 Jun 23;18:3323-3333. doi: 10.2147/IJGM.S521364. eCollection 2025.
White matter lesions (WMLs) are associated with an increased risk of stroke, cognitive impairment, and vascular dementia. Hypertension stands as the most significant modifiable independent risk factor contributing to WMLs. However, little is known about the relationship between WMLs and altered circadian rhythms of blood pressure (BP) in patients with essential hypertension.
This cross-sectional observational study enrolled patients diagnosed with essential hypertension. Participants were stratified into mild, moderate, and severe WMLs subgroups based on Fazekas scale assessments, with a control group of individuals without WMLs. All participants underwent 24-hour ambulatory BP monitoring and were classified according to circadian rhythm patterns: dipper, non-dipper, and antidipper. Comparative analyses were performed on demographic characteristics, ambulatory BP profiles, and circadian rhythm patterns across groups. Univariate analysis and multivariate logistic regression were employed to identify independent risk factors for WMLs.
33 in the control group and 112 in the WMLs group were included. There were significant differences in age, history of diabetes mellitus and cardiovascular disease (<0.05). Compared with the control group, mean 24h systolic BP (SBP), mean daytime SBP (DSBP), and mean nocturnal SBP (NSBP) were greater in the WMLs group, and 24hSBPSD, DSBPSD, DDBPSD, and NSBPSD were greater in the WMLs group (<0.05). The circadian rhythms were significantly different between the WMLs group and the control group (<0.05). Age, non-dipper, and antidipper pattern were found to be independent risk factors for WMLs. Multivariate logistic regression revealed that age (OR 1.128 CI 1.082-1.175, <0.001) and the non-dipper pattern (OR 4.855 CI 1.062-22.184, =0.042) were independent risk factors for WMLs.
Age and non-dipper and antidipper patterns are associated with an increased risk of WMLs. Non-dipper BP is an independent risk factor for WMLs. Middle-aged and elderly people with primary hypertension with non-dipper BP need to manage and control nocturnal BP.
白质病变（WMLs）与中风、认知障碍及血管性痴呆风险增加相关。高血压是导致WMLs的最主要可改变的独立风险因素。然而，原发性高血压患者中WMLs与血压昼夜节律改变之间的关系鲜为人知。
这项横断面观察性研究纳入了诊断为原发性高血压的患者。根据 Fazekas 量表评估，将参与者分为轻度、中度和重度 WMLs 亚组，另有一组无 WMLs 的个体作为对照组。所有参与者均接受 24 小时动态血压监测，并根据昼夜节律模式进行分类：勺型、非勺型和反勺型。对各组的人口统计学特征、动态血压概况和昼夜节律模式进行比较分析。采用单因素分析和多因素逻辑回归来确定 WMLs 的独立危险因素。
对照组纳入 33 人，WMLs 组纳入 112 人。年龄、糖尿病史和心血管疾病史方面存在显著差异（<0.05）。与对照组相比，WMLs 组的 24 小时平均收缩压（SBP）、日间平均 SBP（DSBP）和夜间平均 SBP（NSBP）更高，且 WMLs 组的 24hSBPSD、DSBPSD、DDBPSD 和 NSBPSD 更高（<0.05）。WMLs 组与对照组之间的昼夜节律存在显著差异（<0.05）。年龄、非勺型和反勺型模式被发现是 WMLs 的独立危险因素。多因素逻辑回归显示，年龄（OR 1.128，CI 1.082 - 1.175，<0.001）和非勺型模式（OR 4.855，CI 1.062 - 22.184，=0.042）是 WMLs 的独立危险因素。
年龄以及非勺型和反勺型模式与 WMLs 风险增加相关。非勺型血压是 WMLs 的独立危险因素。患有原发性高血压且血压呈非勺型的中老年人需要控制夜间血压。
