title: Relationship between ambulatory blood pressure and aortic arch atherosclerosis.
abstract: OBJECTIVE
  Atherosclerotic plaque in the aortic arch is an independent risk factor for ischemic stroke. Although high blood pressure (BP) measured at the doctor's office is known to be associated with aortic atherosclerosis, little is known on the association between 24-h ambulatory BP and aortic arch plaque presence and severity. Our objective was to clarify the association between ambulatory BP variables and aortic arch atherosclerosis in a community-based cohort.
  
  
  METHODS
  The study population consisted of 795 patients (mean age 71 ± 9 years) participating in the Cardiovascular Abnormalities and Brain Lesions (CABL) study who underwent 24-h ambulatory BP monitoring (ABPM). Arch plaque was evaluated by 2D transthoracic echocardiography from a suprasternal window.
  
  
  RESULTS
  All systolic ABPM variables (24-h/daytime/nighttime mean systolic BP, daytime/nighttime systolic BP variability) were associated with the presence of any plaque and large (≥ 4 mm) plaque, whereas diastolic BP variables were not associated with aortic atherosclerosis. Multiple regression analysis indicated that nighttime systolic BP variability (expressed as the standard deviation of nighttime systolic BP) remained independently associated with large plaque after adjustment for age, sex, cigarette smoking, history of hypertension, diabetes mellitus, hypercholesterolemia, anti-hypertensive medication and nighttime mean systolic BP (odds ratio 1.39 per 1 standard deviation increase, 95% CI 1.00-1.93, P<0.05).
  
  
  CONCLUSIONS
  Systolic ABPM variables are significantly associated with the presence of arch plaque. Nighttime systolic BP variability is independently associated with large arch plaque. These findings may have important implications in gaining further insights into the mechanism of arch plaque formation and progression.
authors.affiliation: Department of Medicine, Columbia University, New York, NY 10032, USA.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwata
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D013599:Systole; D014463:Ultrasonography