title: Reverse-dipper pattern of blood pressure may predict lacunar infarction in patients with essential hypertension.
abstract: OBJECTIVE
  The fluctuation of circadian blood pressure (BP) is of great diversity in patients with essential hypertension and may provide significant prognostic value for stroke. However, it remains uncertain whether reverse-dipper pattern of BP influences the incidence of lacunar infarction in hypertensive patients.
  
  
  METHODS
  In the current study, 362 hypertensive patients (195 males, 167 females) were enrolled. BP patterns were evaluated with 24-h ambulatory BP monitoring (ABPM). Multinomial logistic regression was applied to analyse the possible relationships between lacunar infarction and various clinical risk factors such as ABPM.
  
  
  RESULTS
  A total of 93 patients (25.7%) had reverse-dipper BP pattern. Non-dipper pattern of BP was observed in 179 hypertensive patients (49.4%) and dipper pattern in 90 patients (24.9%). The percentage of lacunar infarction was the highest in the patients with reverse-dipper pattern compared with pure hypertension or atherothrombotic cerebral infarction (P < 0.05). After multinomial logistic regression analysis, reverse-dipper pattern of BP (odds ratio 2.492; 95% confidence interval 1.133-5.479; P < 0.05) and age (odds ratio 1.084; 95% confidence interval 1.047-1.123; P < 0.01) were found to be directly associated with lacunar infarction.
  
  
  CONCLUSIONS
  Reverse-dipper BP pattern may serve as an independent risk factor for lacunar infarction and more personalized BP management should be offered to the patients who have elevated nocturnal BP.
authors.affiliation: Department of Emergency Medicine, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: B
authors.initials: B
authors.lastname: Yan
authors.forename: L
authors.initials: L
authors.lastname: Peng
authors.forename: Q
authors.initials: Q
authors.lastname: Dong
authors.forename: F
authors.initials: F
authors.lastname: Zheng
authors.forename: P
authors.initials: P
authors.lastname: Yang
authors.forename: L
authors.initials: L
authors.lastname: Sun
authors.forename: S
authors.initials: S
authors.lastname: Gong
authors.forename: L
authors.initials: L
authors.lastname: Zeng
authors.forename: G
authors.initials: G
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology*; D000075222:Essential Hypertension; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000175:diagnosis / Q000503:physiopathology*
keywords: blood pressure; essential hypertension; lacunar infarction; reverse-dipper pattern