Low nocturnal blood pressure is associated with reduced cerebral blood flow in the cohort “Men born in 1914”

Abstract

BACKGROUND: “Men born in 1914” is a population-based cohort study of the epidemiology of cardiovascular and cerebral disease. Little is known about how diurnal variation in blood pressure (BP) levels influence cerebral perfusion in very elderly populations. OBJECTIVES: To study the association between systolic (SBP) and diastolic BP (DBP) levels, during the day and at night, expressed through 24 h ambulatory BP monitoring (ABPM) and regional cerebral blood flow (rCBF) disturbances.

METHODS: A cross-sectional study from a population-based cohort of 108 men 81 years of age (born in 1914) was performed in an outpatient university clinic. Cerebral blood flow measurements using 99mTc-hexamethylpropyleneamine oxime single photon emission computed tomography and 24 h ABPM were performed. Eleven men were excluded due to incomplete ABPM data.

RESULTS: Mean DBP at night for each tertile was correlated to rCBF for the medial temporal right (P=0.012) and left (P=0.039) regions. Also, DBP during the day was correlated to the medial temporal right region (P=0.025). When analyses were stratified for DBP during the day, subjects with high DBP during the day (greater than 70 mmHg) showed a stronger association between low medial temporal right rCBF and low mean DBP at night (r=0.32, P=0.009) compared with subjects who had a lower daytime DBP. A corresponding positive correlation was noted for the medial temporal left region and daytime SBP, whereas a negative correlation was noted for frontal left region blood flow and SBP at night.

CONCLUSIONS: A significant association was seen between low BP levels, especially at night, and rCBF in subjects with otherwise normal daytime DBP that may indicate a risk for nocturnal cerebral ischemia.

Blood pressure monitoring; Cerebral autoregulation; Cohort study; Nocturnal blood pressure, Regional cerebral blood flow