Impact of Circadian Blood Pressure Pattern on Silent Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis

Abstract

Background Abnormal circadian blood pressure (BP) variations during sleep, specifically the non-dipping (<10% fall in nocturnal BP) and reverse-dipping patterns (rise in nocturnal BP), have been associated with an increased risk of cardiovascular events and target organ damage. However, the relationship between abnormal sleep BP variations and cerebral small vessel disease markers is poorly established. This study aims to assess the association between non-dipping and reverse-dipping BP patterns with markers of silent cerebral small vessel disease. Methods and Results MEDLINE, Embase, and Cochrane Databases were searched from inception through November 2019. Studies that reported the odds ratios (ORs) for cerebral small vessel disease markers in patients with non-dipping or reverse-dipping BP patterns were included. Effect estimates from the individual studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Twelve observational studies composed of 3497 patients were included in this analysis. The reverse-dipping compared with normal dipping BP pattern was associated with a higher prevalence of white matter hyperintensity with a pooled adjusted OR of 2.00 (95% CI, 1.13-2.37; I²=36%). Non-dipping BP pattern compared with normal dipping BP pattern was associated with higher prevalence of white matter hyperintensity and asymptomatic lacunar infarction, with pooled ORs of 1.38 (95% CI, 0.95-2.02; I²=52%) and 2.33 (95% CI, 1.30-4.18; I²=73%), respectively. Limiting to only studies with confounder-adjusted analysis resulted in a pooled OR of 1.38 (95% CI, 0.95-2.02; I²=52%) for white matter hyperintensity and 1.44 (95% CI, 0.97-2.13; I²=0%) for asymptomatic lacunar infarction. Conclusions The non-dipping and reverse-dipping BP patterns are associated with neuroimaging cerebral small vessel disease markers.

Keywords: blood pressure variability; circadian; meta‐analysis; microbleed; white matter.

Figure 1. Outline of our selection process.

Figure 2. Forest plot of the association between reverse‐dipping pattern and silent cerebral small vessel disease neuroimaging features.

A, Forest plots of included studies assessing the association between reverse‐dipping pattern and white matter hyperintensity. B, Forest plots of the included studies assessing the association between reverse‐dipping pattern and asymptomatic lacunar infarct. A diamond data marker depicts the overall rate from included studies (square data markers) and 95% CI. WMH indicates white matter hypersensitivity.

Figure 3. Forest plot of the association between non‐dipping pattern and silent cerebral small vessel disease neuroimaging features.

A, Forest plots of the included studies assessing the association between non‐dipping pattern and white matter hyperintensity. B, Forest plots of the included studies assessing association between non‐dipping pattern and asymptomatic lacunar infarction . C, Forest plots of the included studies assessing association between non‐dipping pattern and cerebral microbleeds. A diamond data marker depicts the overall rate from included studies (square data markers) and 95% CI. CMB indicates cerebral microbleeds; and WMH, white matter hypersensitivity.