Effect Of Blood Pressure Circadian Rhythm On White Matter Hyperintensity In Patients With Essential Hypertension

Objective:Non-dipping and anti-dipping patterns of changes in circadian blood pressure such as no drop or elevation of blood pressure at night are associated with an increased risk of cerebrovascular disease,cardiovascular events,and all-cause mortality.However,Few people know the relationship between white matter hyperintensity and non-dipping,anti-dipping blood pressure patterns in patients with primary hypertension.The objective of this article was to investigate whether WMH and the severity of WMH in patients with primary hypertension correlate with the circadian pattern of blood pressure measured by 24-hour ambulatory blood pressure monitoring,and to provide guidance for the prevention of WMH in patients with primary hypertension.Non-dipping and anti-dipping patterns of changes in circadian blood pressure such as no drop or elevation of blood pressure at night are associated with an increased risk of cerebrovascular disease,cardiovascular events,and all-cause mortality.Methods:A total of 145 patients diagnosed with primary hypertension and well controlled blood pressure in the Department of Neurology,Second Affiliated Hospital of Nanchang University from January 1,2021 to December 31,2022 were collected,Craniocerebral magnetic resonance imaging was completed in all enrolled patients.WMH was evaluated according to the modified Fazakas visual score scale,divided into control group and WMH group,and then divided into three subgroups of mild,moderate and severe according to the severity of WMH,and all enrolled patients underwent 24-hour ambulatory blood pressure monitoring after completing cranial magnetic resonance examination.The basic information,blood pressure level,blood pressure variability and blood pressure circadian rhythm changes of each group were recorded and compared,and the differences between the control group and the WMH group,and the control group and the mild,moderate and severe WMH group were analyzed respectively.Results:1.Basic information:There were 33 people(23%)in the control group(Fazekas grade=grade 0),112(77%)in the WMH group(Fazekas grade≧1),and 43(38%)(Fazekas grade=grade1),37 moderate(33%)(Fazekas grade=grade 2),and 32 severe(Fazekas grade=grade3)according to WMH severity.Compared with the control group,there were significant differences in age,diabetes history,and cardiovascular history between the WMH group(P<0.05),there were no statistically significant differences in smoking history,body mass index,total cholesterol,triglyceride,low density lipoprotein,uric acid,homocysteine,C-reactive protein,glycosylated hemoglobin,systolic blood pressure,diastolic blood pressure and the course of hypertension.2.24-hour ambulatory blood pressure monitoring:(1)The 24 h SBP,DSBP and NSBP in the WMH group were higher than those in the control group,and there were significant differences between the two groups(P<0.05).(2)Compared with the control group,24 h SBPSD,DSBPSD,DDBPSD,NSBPSD increased in WMH group(P<0.05).(3)There was a statistically significant difference in blood pressure circadian rhythm between the WMH group and the control group(P<0.05).3.Binary logistic regression analysis showed that age,non-dipping blood pressure pattern and reverse dipping blood pressure pattern were independent risk factors for WMH.4.Multivariate ordered logistic regression analysis showed that age and nondipping blood pressure patterns were independent risk factors for WMH severity.Conclusions:1.WMH may progress in the presence of circadian changes in blood pressure,such as non-dipping and anti-dipping blood pressure,even if blood pressure is well controlled in the office.2.Age and ABPM-measured non-dipping and anti-dipping blood pressure patterns are associated with an increased risk of WMH,independent of traditional risk factors.3.Non-dipping blood pressure patterns are independent risk factors for WMH severity.Middle-aged and older people with essential hypertension who are not on a dipping blood pressure pattern may need to manage and control nighttime blood pressure to reduce the risk of developing WMH.