Correlation Of Abnormal Circadian Rhythm Of Blood Pressure With Carotid Atherosclerosis And Lacunar Infarction

Objective:To investigate the correlation of abnormal circadian rhythm of blood pressure with carotid atherosclerosis and lacunar infarction in patients with essential hypertension.Methods:24-h ambulatory blood pressure monitoring (ABPM) was applied in179patients with essential hypertension. According to the rate of decline in nocturnal blood pressure, the patients were divided into three groups:dipper group (n=73), non-dipper group (n=72) and reverse dipper group (n=34).Color Doppler ultrasonography was performed in all patients to assess the carotid artery intima-media thickness and the carotid artery plaque. The lacunar infarction was reported by MRI (magnetic resonance imaging). The differences of ambulatory blood pressure parameters, carotid artery intima-media thickness and plaque and the incidence of lacunar infarction among groups were analyzed.Results:①. The ratio of dipper non dipper and reverse dipper among patients with essential hypertension were40.78%(73cases)、40.22%(72cases) and18.99%(34cases) respectively.②. The level of24hSBP、24hPP、nDBP、nMBP and nPP of reverse dipper group and non dipper group was significantly higher than that of dipper group(P<0.05), there was no statistical difference between reverse dipper group and non dipper group about24hSBP、4hPP、nDBP; the level of dDBP of both dipper group and non dipper was significantly higher than that of reverse dipper group(P<0.05), but there was not different between dipper group and non dipper group statistically(P>0.05). The level of nSBP、nMBP and nPP of the reverse dipper group was highest, the dipper group was lowest and the non dipper group was midst(P<0.05).③. The CAIMT of the dipper group、non dipper group and reverse dipper group was (0.93±0.19) mm、(1.03±0.15) mm and (1.17±0.18) mm. The level of CAIMT of non dipper group and reverse dipper group were significantly higher than that of dipper group(P<0.05). The level of CAIMT of reverse dipper group was significantly higher than that of non dipper group (P<0.05).④. The detection rate of carotid artery plaque of dipper group was19.18%, non dipper group was63.89%and reverse dipper was64.71%. The detection rate of carotid artery plaque of non dipper group and reverse dipper group were significantly higher than that of dipper group(P<0.05), there was no statistical difference between reverse dipper group and non dipper group(P>0.05).⑤. The rate of lacunar infarction of dipper group was15.07%, non dipper group was37.50%and reverse dipper was55.88%respectively. The rate of lacunar infarction of reverse dipper group and non dipper group was significantly higher than that of dipper group (P<0.05), the rate of lacunar Infarction of reverse dipper group was significantly higher than that of non dipper group(P<0.05).⑥.The level of CAIMT was related to the rate of decline in nocturnal blood pressure negatively(P<0.05).Conclusion:This study showed that the level of CAIMT、carotid artery plaque detection rate and the rate of lacunar Infarction in reverse dipper group and non dipper group were higher than those in dipper group among patients with essential hypertension. Circadian rhythm abnormality of blood pressure was associated with more serious carotid atherosclerosis and occurrence of lacunar infarction, especially in those with reverse dipper circadian rhythm.