Relationship between 24-hour blood pressure circadian rhythm and imaging markers in patients with arteriolosclerotic cerebral small vessel disease

doi:10.3877/cma.j.issn.1673-9248.2026.02.007

Abstract

Abstract:

Objective

To explore the relationship between 24-hour ambulatory blood pressure circadian rhythm and imaging markers in patients with arteriolosclerosis cerebral small vessel disease (aCSVD).

Methods

A total of 352 patients with aCSVD who underwent 24-hour ambulatory blood pressure monitoring during their hospitalization in the Department of Neurology at Beijing Zhongguancun Hospital from January 1, 2018, to December 31, 2024 were retrospectively included. General clinical data and imaging characteristics of aCSVD were recorded. According to the circadian rhythm of 24-hour ambulatory blood pressure, patients were categorized into three groups: dipper group (n=34), non-dipper group (n=147), and reverse-dipper group (n=171). Analysis of variance, Kruskal-Wallis H test and χ² test were used to compare the differences in general data and imaging features of cerebral small vessel disease among the three groups of patients. Logistic regression analysis was conducted to explore the influence of 24-hour blood pressure circadian rhythm on imaging markers of CSVD.

Results

The age of patients [(76.88±12.03) years vs (70.24±13.40), (72.19±12.44) years, t=-2.885, -3.412; P=0.013, 0.002] and the proportion of grade 3 hypertension (67.3% vs 41.2%, 46.9%, χ²=8.266, 13.377; P=0.004, 0.001) in the reverse-dipper group were significantly higher than those in the dipper and non-dipper groups. The duration of hypertension history [10 (5, 20) years vs 10 (1, 20) years, Z=-2.562, P=0.010] and the use of β-blockers (23.5% vs 10.9%, χ²=8.666, P=0.003) in the reverse-dipper group were significantly greater compared to those in the non-dipper group. The severity of white matter hyperintensities (periventricular and deep white matter) and perivascular spaces in the basal ganglia in the reverse-dipper group was significantly greater than those in the dipper and non-dipper groups (all P<0.05). The proportion of cerebral microbleeds (25.1% vs 8.8%) in the reverse-dipper group was significantly higher than that in the dipper group (χ²=4.432, P=0.037). Multivariate Logistic regression analysis showed that reverse-dipper blood pressure (OR_DWMH=2.36, 95%CI: 1.13-4.95, P=0.023; OR_PVWH=3.97, 95%CI: 1.90-8.30, P=0.001; OR_BG-PVS=2.12, 95%CI: 1.02-4.37, P=0.042) were independent risk factors for deep white matter hyperintensities, periventricular white matter hyperintensities, and perivascular spaces in the basal ganglia.

Conclusion

24-hour blood pressure circadian rhythms are associated with imaging markers of aCSVD, and reverse-dipper patterns may significantly increase the risk of white matter hyperintensities and basal ganglia perivascular spaces.

Key words: Blood pressure circadian rhythms, Cerebral small vessel disease, Arteriolosclerosis, Imaging markers

Lijuan Wang, Ying Liu, Mingyu Cui, Hao Li, Xiaolan Yu, Xin Liu. Relationship between 24-hour blood pressure circadian rhythm and imaging markers in patients with arteriolosclerotic cerebral small vessel disease[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(02): 157-163.

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Figures/Tables 3

变量	杓型组（n=34）	非杓型组（n=147）	反杓型组（n=171）	统计值	P值
年龄（岁， $x ¯$ ±s）	70.24±13.40	72.19±12.44	76.88±12.03^ab	F=7.735	0.001
男例[例（%）]	21（61.8）	83（56.5）	99（57.9）	χ²=0.325	0.850
高血压[例（%）]	29（85.3）	121（82.3）	149（87.1）	χ²=1.440	0.487
糖尿病[例（%）]	17（50.0）	64（43.5）	75（43.9）	χ²=0.496	0.780
冠心病[例（%）]	7（20.6）	35（23.8）	57（33.3）	χ²=4.604	0.100
吸烟史[例（%）]	10（29.4）	42（28.6）	46（26.9）	χ²=0.156	0.925
饮酒史[例（%）]	9（26.5）	26（17.7）	31（18.1）	χ²=1.483	0.476
高血压病史时间[年，M（Q₁，Q₃）]	10（1，11）	10（1，20）	10（5，20）^b	H=7.810	0.020
高血压分级[例（%）]				χ²=18.593	0.005
正常	5（14.7）	22（15.0）	20（11.7）
1级	6（17.6）	17（11.6）	12（7.0）
2级	9（26.5）	39（26.5）	24（14.0）
3级	14（41.2）	69（46.9）	115（67.3）^ab
降压药物应用[例（%）]
CCB	16（47.1）	87（59.2）	103（60.6）	χ²=2.165	0.339
ACEI	0（0）	5（3.4）	6（3.5）	χ²=1.222	0.543
β受体阻滞剂	4（11.8）	16（10.9）	40（23.5）^b	χ²=9.649	0.008
ARB	16（47.1）	50（34）	59（34.7）	χ²=2.168	0.338
利尿剂	6（17.6）	27（18.4）	49（28.8）	χ²=5.501	0.064
LDL-C（mmol/L， $x ¯$ ±s）	2.18±0.79	2.38±0.86	2.18±0.77	F=2.589	0.077
HDL-C[mmol/L，M（Q₁，Q₃）]	1.06（0.78，1.12）	1.04（0.89，1.24）	0.96（0.82，1.14）	H=4.280	0.118
TC（mmol/L， $x ¯$ ±s）	3.68±1.01	3.97±1.15	3.78±1.08	F=1.587	0.206
TG[mmol/L，M（Q₁，Q₃）]	0.99（0.83，1.39）	1.16（0.87，1.57）	1.22（0.95，1.61）	H=3.773	0.152
血糖[mmol/L，M（Q₁，Q₃）]	5.66（5.16，6.53）	5.58（4.85，7.00）	5.66（4.86，6.91）	H=0.312	0.856
血红蛋白（g/L， $x ¯$ ±s）	130.12±18.50	129.45±17.74	124.10±19.05^b	F=3.770	0.024
肌酐[μmol/L，M（Q₁，Q₃）]	71（62，84）	68（57，84）	69（58，88）	H=0.722	0.697
eGFR[mL/（min·1.73 m²）， $x ¯$ ±s]	94.52±28.90	93.37±24.62	92.87±31.22	F=0.050	0.951

变量	杓型组（n=34）	非杓型组（n=147）	反杓型组（n=171）	统计值	P值
年龄（岁， $x ¯$ ±s）	70.24±13.40	72.19±12.44	76.88±12.03^ab	F=7.735	0.001
男例[例（%）]	21（61.8）	83（56.5）	99（57.9）	χ²=0.325	0.850
高血压[例（%）]	29（85.3）	121（82.3）	149（87.1）	χ²=1.440	0.487
糖尿病[例（%）]	17（50.0）	64（43.5）	75（43.9）	χ²=0.496	0.780
冠心病[例（%）]	7（20.6）	35（23.8）	57（33.3）	χ²=4.604	0.100
吸烟史[例（%）]	10（29.4）	42（28.6）	46（26.9）	χ²=0.156	0.925
饮酒史[例（%）]	9（26.5）	26（17.7）	31（18.1）	χ²=1.483	0.476
高血压病史时间[年，M（Q₁，Q₃）]	10（1，11）	10（1，20）	10（5，20）^b	H=7.810	0.020
高血压分级[例（%）]				χ²=18.593	0.005
正常	5（14.7）	22（15.0）	20（11.7）
1级	6（17.6）	17（11.6）	12（7.0）
2级	9（26.5）	39（26.5）	24（14.0）
3级	14（41.2）	69（46.9）	115（67.3）^ab
降压药物应用[例（%）]
CCB	16（47.1）	87（59.2）	103（60.6）	χ²=2.165	0.339
ACEI	0（0）	5（3.4）	6（3.5）	χ²=1.222	0.543
β受体阻滞剂	4（11.8）	16（10.9）	40（23.5）^b	χ²=9.649	0.008
ARB	16（47.1）	50（34）	59（34.7）	χ²=2.168	0.338
利尿剂	6（17.6）	27（18.4）	49（28.8）	χ²=5.501	0.064
LDL-C（mmol/L， $x ¯$ ±s）	2.18±0.79	2.38±0.86	2.18±0.77	F=2.589	0.077
HDL-C[mmol/L，M（Q₁，Q₃）]	1.06（0.78，1.12）	1.04（0.89，1.24）	0.96（0.82，1.14）	H=4.280	0.118
TC（mmol/L， $x ¯$ ±s）	3.68±1.01	3.97±1.15	3.78±1.08	F=1.587	0.206
TG[mmol/L，M（Q₁，Q₃）]	0.99（0.83，1.39）	1.16（0.87，1.57）	1.22（0.95，1.61）	H=3.773	0.152
血糖[mmol/L，M（Q₁，Q₃）]	5.66（5.16，6.53）	5.58（4.85，7.00）	5.66（4.86，6.91）	H=0.312	0.856
血红蛋白（g/L， $x ¯$ ±s）	130.12±18.50	129.45±17.74	124.10±19.05^b	F=3.770	0.024
肌酐[μmol/L，M（Q₁，Q₃）]	71（62，84）	68（57，84）	69（58，88）	H=0.722	0.697
eGFR[mL/（min·1.73 m²）， $x ¯$ ±s]	94.52±28.90	93.37±24.62	92.87±31.22	F=0.050	0.951

变量	杓型组（n=34）	非杓型组（n=147）	反杓型组（n=171）	统计值	P值
脑室旁白质高信号（分）				H=32.035	0.001
0	14（41.2）	36（24.5）	24（14.0）
1	13（38.2）	59（40.1）	45（26.3）
2	3（8.8）	34（23.1）	46（26.9）
3	4（11.8）	18（12.2）	56（32.7）^ab
深部白质高信号（分）				H=12.475	0.002
0	18（52.9）	51（34.7）	42（24.6）
1	9（26.5）	64（43.5）	70（40.9）
2	6（17.6）	15（10.2）	33（19.3）
3	1（2.9）	17（11.6）	26（15.2）^ab
基底节区血管周围间隙（级）				H=21.282	0.001
0	6（17.6）	12（8.2）	10（5.8）
1	16（47.1）	80（54.4）	64（37.4）
2	7（20.6）	31（21.1）	44（25.7）
3	5（14.7）	24（16.3）	53（31.0）^ab
半卵圆中心血管周围间隙（级）				H=1.929	0.381
0	12（35.3）	43（29.3）	54（31.6）
1	14（41.2）	57（38.8）	76（44.4）
2	6（17.6）	24（16.3）	19（11.1）
3	2（5.9）	23（15.6）	22（12.9）
腔隙				χ²=4.073	0.131
有	24（70.6）	113（76.9）	143（83.6）
无	10（29.4）	34（23.1）	28（16.4）
脑微出血				χ²=4.672	0.097
有	3（8.8）	30（20.4）	43（25.1）^a
无	31（91.2）	117（79.6）	128（74.9）

项目	深部白质高信号			脑室旁白质高信号			基底节区血管周围间隙
项目	OR值	95%CI	P值	OR值	95%CI	P值	OR值	95%CI	P值
年龄	1.05	1.03~1.08	0.001	1.09	1.06~1.11	0.001	1.06	1.04~1.08	0.001
高血压病史	1.01	0.99~1.03	0.156	1.00	0.98~1.02	0.963	1.00	0.98~1.02	0.713
高血压分级
正常	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
1级	1.32	0.65~2.66	0.440	1.31	0.65~1.63	0.455	0.83	0.41~1.69	0.604
2级	0.92	0.54~1.56	0.748	1.05	0.61~1.79	0.854	0.70	0.41~1.21	0.207
3级	0.99	0.50~1.98	0.986	0.67	0.34~1.34	0.263	0.68	0.34~1.35	0.265
β受体阻滞剂	0.88	0.51~1.52	0.631	0.92	0.53~1.60	0.776	0.75	0.44~1.32	0.330
血红蛋白	1.00	0.99~1.02	0.360	0.99	0.99~1.01	0.792	1.01	0.99~1.02	0.107
血压昼夜节律
杓型	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
非杓型	1.82	0.87~3.80	0.110	1.98	0.95~4.10	0.066	1.24	0.60~2.53	0.560
反杓型	2.36	1.13~4.95	0.023	3.97	1.90~8.30	0.001	2.12	1.02~4.37	0.042

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