title: Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients.
abstract: Nocturnal variations in blood pressure (BP) were associated with carotid intima-media thickness. However, the precise relationship between circadian variations of BP and carotid plaques remains unknown. Therefore, the prognostic value of reverse-dipper pattern of BP for carotid plaque was investigated. In this cross-sectional study, a total of 524 hypertensive patients were recruited and evaluated with ambulatory BP monitoring between April 2012 and June 2013. Carotid plaque was classified into Grade 0 (normal or no observable plaque), Grade 1 (mild stenosis, 1%-24% narrowing), and Grade 2 (moderate stenosis, ≥25% narrowing). Multinomial logistic regression was applied to analyze the relationship between different degrees of carotid plaque and ambulatory BP monitoring results. Reverse-dipper pattern of BP was more common in older patients, smokers, and those with elevated fasting glucose. The incidences of coronary artery disease, lacunar infarction, and diabetes were also higher among hypertensive with reverse-dipper pattern. Multinomial logistic regression analysis showed that reverse dipper (odds ratio [OR] 2.500; 95% confidence interval [CI] 1.320-4.736; P = 0.005), age (OR 1.089; 95% CI 1.067-1.111; P < 0.001), smoke (OR 1.625; 95% CI 1.009-2.617; P = 0.046), and diabetes (OR 1.759; 95% CI 1.093-2.830; P = 0.020) were significantly different between mild carotid plaque and normal. Our results also suggested that mild carotid plaque was closely related to reverse-dipper pattern of BP (2.308; 95% CI 1.223-4.355; P = 0.010). Reverse-dipper pattern of BP may be a risk factor for carotid atherosclerosis and play a crucial role in the early formation of carotid plaque.
authors.affiliation: From the Department of Emergency Medicine (BY, GW); Department of Cardiology (LP); Department of Ultrasound (DH, LS); Department of Neurosurgery (QD, FZ); Department of Oncology, the Second Affiliated Hospital, Xi'an Jiaotong University Xi'an, China (PY); Division of Cardiology, Khoo Teck Puat Hospital, Singapore (HYO); and Cardiovascular division, King's College London, British Heart Foundation Centre, London, United Kingdom (LZ).
authors.forename: Bin
authors.initials: B
authors.lastname: Yan
authors.forename: Liyuan
authors.initials: L
authors.lastname: Peng
authors.forename: Donggang
authors.initials: D
authors.lastname: Han
authors.forename: Lu
authors.initials: L
authors.lastname: Sun
authors.forename: Quan
authors.initials: Q
authors.lastname: Dong
authors.forename: Pengtao
authors.initials: P
authors.lastname: Yang
authors.forename: Fengwei
authors.initials: F
authors.lastname: Zheng
authors.forename: HeanYee
authors.initials: H
authors.lastname: Ong
authors.forename: Lingfang
authors.initials: L
authors.lastname: Zeng
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D016893:Carotid Stenosis / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis