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Dirk Sander, MD; Kerstin Winbeck, MD; Jürgen Klingelhöfer, MD; Bastian Conrad, MD

Arch Neurol. 2000;57:1302-1307.

Objective  To evaluate the relationship between circadian blood pressure patterns and the extent of cerebral white matter lesions (WML).

Design  Case-control study.

Participants  A total of 227 healthy subjects older than 55 years were investigated. Extent and occurrence of WML were evaluated using a computer-supported image analysis system. Circadian blood pressure variation was defined as the average percentage change of nighttime blood pressure compared with the daily blood pressure values.

Results  Subjects with WML were significantly older and showed more often a history of hypertension, elevated average systolic daily blood pressure, a reduced systolic circadian blood pressure variation, and an increased incidence of pathological nighttime blood pressure increases. A significant correlation was found between systolic circadian blood pressure variation and the extent of WML. A multiple regression analysis revealed that this parameter was best correlated with the extent of WML.

Conclusion  In addition to the absolute level of blood pressure, systolic circadian blood pressure variation and in particular a systolic nighttime blood pressure increase may play an important role in the pathogenesis of WML.

From the Department of Neurology, Technical University of Munich (Drs Sander, Winbeck, and Conrad) and Klinikum Chemnitz (Dr Klingelhöfer), Munich, Germany.

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