Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline - The Ohasama study
Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline - The Ohasama study
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DOI：
10.1161/01.hyp.0000198541.12640.0f
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发表时间：
2006-02-01
期刊：
影响因子：
8.3
通讯作者：
Imai, Y
中科院分区：
文献类型：
--
作者：
Metoki, H;Ohkubo, T;Imai, Y
昼夜血压（BP）变化模式（包括夜间血压下降和早晨血压升高）是否对卒中风险具有预后意义仍存在争议。在这项研究中，我们对日本Ohasama的1430名年龄≥ 40岁的受试者的卒中发病率进行了平均10.4年的随访。调整可能的混杂因素后，采用考克斯比例风险模型分析中风风险与昼夜血压变化模式之间的关系。总卒中风险与夜间血压下降（相对于昼夜血压水平下降的百分比）或总卒中风险与早晨升压峰之间无显著相关性。夜间血压下降≥ 10%的受试者发生脑梗死的风险显著较高< 10% nocturnal decline in BP as compared with subjects who had a >（P = 0.04）。早晨升压峰与脑梗死风险无关。另一方面，在早晨出现大幅度升压峰的受试者中观察到脑出血的风险增加（>= 25 mm Hg; P = 0.04）。极勺型患者（夜间血压下降>= 20%）的脑出血发生率也高于勺型患者（夜间血压下降10%-19%; P = 0.02）。夜间血压下降紊乱与脑梗死相关，而清晨血压大幅升高和夜间血压大幅下降（类似于昼夜血压大幅升高）均与脑出血相关。
There is continuing controversy over whether the pattern of circadian blood pressure ( BP) variation that includes a nocturnal decline in BP and a morning pressor surge has prognostic significance for stroke risk. In this study, we followed the incidence of stroke in 1430 subjects aged >= 40 years in Ohasama, Japan, for an average of 10.4 years. The association between stroke risk and the pattern of circadian BP variation was analyzed with a Cox proportional hazards model after adjustment for possible confounding factors. There was no significant association between total stroke risk and the nocturnal decline in BP ( percentage decline from diurnal level) or between total stroke risk and the morning pressor surge. The cerebral infarction risk was significantly higher in subjects with a < 10% nocturnal decline in BP as compared with subjects who had a >= 10% nocturnal decline in BP ( P = 0.04). The morning pressor surge was not associated with a risk of cerebral infarction. On the other hand, an increased risk of cerebral hemorrhage was observed in subjects with a large morning pressor surge ( >= 25 mm Hg; P = 0.04). Intracerebral hemorrhage was also observed more frequently in extreme dippers ( those with a >= 20% nocturnal decline in BP) than dippers ( those with a 10% to 19% decline; P = 0.02). A disturbed nocturnal decline in BP is associated with cerebral infarction, whereas a large morning pressor surge and a large nocturnal decline in BP, which are analogous to a large diurnal increase in BP, are both associated with cerebral hemorrhage.