The Relationship Between Nighttime Dipping in Blood Pressure and Cerebral Hemodynamics in Nonstroke Patients

Authors

  • Ihab Hajjar MD, MS,

    1. From the Beth Israel Deaconess Medical Center;1Harvard Medical School;2the Institute for Aging Research at Hebrew SeniorLife;3 and Boston University,4 Boston, MA
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  • 1,2,3 Magdy Selim MD, PhD,

    1. From the Beth Israel Deaconess Medical Center;1Harvard Medical School;2the Institute for Aging Research at Hebrew SeniorLife;3 and Boston University,4 Boston, MA
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  • 1,2 Peter Novak MD, PhD,

    1. From the Beth Israel Deaconess Medical Center;1Harvard Medical School;2the Institute for Aging Research at Hebrew SeniorLife;3 and Boston University,4 Boston, MA
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  • and 4 Vera Novak MD, PhD 1,2

    1. From the Beth Israel Deaconess Medical Center;1Harvard Medical School;2the Institute for Aging Research at Hebrew SeniorLife;3 and Boston University,4 Boston, MA
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Ihab Hajjar, MD, MS, Division of Gerontology, Beth Israel Deaconess Medical Center, Institute for Aging Research at Hebrew SeniorLife and Harvard Medical School, 1200 Centre Street, Boston, MA 02131
E-mail: ihabhajjar@hrca.harvard.edu

Abstract

Inadequate dipping in nighttime blood pressure (BP) is associated with cerebrovascular disease. The authors aimed to determine whether inadequate nocturnal dipping was associated with abnormalities in cerebrovascular hemodynamics in individuals without stroke. Participants in this study underwent 24-hour ambulatory BP monitoring followed by morning transcranial Doppler measurements of blood flow velocities (BFVs) in the middle cerebral artery during supine rest, head-up tilt, hypocapnia, and hypercapnia. Nighttime BP decline by <10% was considered nondipping. Of the 102 nonstroke participants (mean age, 53.6 years), 35 (34%) were dippers. Although nondippers had similar BFV and cerebrovascular resistance (CVR) while supine, they had a lower BFV (P=.04) and greater CVR (P=.02) during head-up tilt compared with dippers. Moreover, greater nighttime dipping in both systolic BP (P=.006) and diastolic BP (P=.03) were associated with higher daytime BFV and lower CVR (P=.01 for systolic BP; P=.02 for diastolic BP). Inadequate nocturnal BP dipping is associated with lower daytime cerebral blood flow, especially during head-up tilt.

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