The structural and functional consequences of diurnal variations in blood pressure in treated patients with hypertensive cerebrovascular disease

Background Although hypertension is known to cause brain damage and cognitive impairment, epidemiological studies suggest that lower blood pressure (BP) in patients with established cerebrovascular disease is associated with more rapid cognitive decline. We investigated the relationship between 24-h ambulatory blood pressure (ABP) measurements, cerebrovascular disease load and cognitive performance in patients with hypertensive cerebrovascular disease. Methods Eighty-eight patients (mean age 65+9 years) with hypertensive cerebrovascular disease on MRI were recruited. BP was controlled optimally. ABP monitoring, quantitative MRI analysis of white matter lesion (WML) volume and executive cognitive function tests were performed. The relationships between ABP variables, WML volume and executive test performance were examined using regression analyses to adjust for age, sex, vascular risk profile and premorbid intelligence. Results Patients had a mean daytime ABP of 96+10 mmHg and mean night-time ABP of 88+11 mmHg (P = 0.001). Median WML volume was 8464 mm(3). There were no significant associations between ABP variables and supratentorial WML volumes. Infratentorial WML volume correlated negatively with night-time mean BP (r = -0.6, P = 0.002) and positively with nocturnal dipping (r = 0.6, P = 0.002). Higher night-time mean BP was an independent predictor of reduced infratentorial WML volume (R-2: 0.460, P = 0.008). Infratentorial WML volume correlated with impairments of phonemic verbal fluency (r = 0.5, P<0.001) and choice reaction time (r = 0.7, P<0.005). Conclusion Physiological falls in nocturnal BP may be associated with increased infratentorial WML volume and cognitive dysfunction in optimally controlled hypertensive patients with cerebrovascular disease. J Hypertens 27:1042-1048 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.