Yu Shen,1,* Wenwen Xiang,2,* Shenjian Chen,2 Zhou Hou,2,3 Daojun Hong1 

1Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China; 2Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China; 3Department of Neurology, Baoji People’s Hospital, Baoji, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Zhou Hou, Department of Neurology, Baoji People’s Hospital, Baoji, 721000, People’s Republic of China, Email 1394271984@qq.com Daojun Hong, Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of China, Email hongdaojun@hotmail.com

Background: White matter lesions (WMLs) are associated with an increased risk of stroke, cognitive impairment, and vascular dementia. Hypertension stands as the most significant modifiable independent risk factor contributing to WMLs. However, little is known about the relationship between WMLs and altered circadian rhythms of blood pressure (BP) in patients with essential hypertension.
Methods: This cross-sectional observational study enrolled patients diagnosed with essential hypertension. Participants were stratified into mild, moderate, and severe WMLs subgroups based on Fazekas scale assessments, with a control group of individuals without WMLs. All participants underwent 24-hour ambulatory BP monitoring and were classified according to circadian rhythm patterns: dipper, non-dipper, and antidipper. Comparative analyses were performed on demographic characteristics, ambulatory BP profiles, and circadian rhythm patterns across groups. Univariate analysis and multivariate logistic regression were employed to identify independent risk factors for WMLs.
Results: 33 in the control group and 112 in the WMLs group were included. There were significant differences in age, history of diabetes mellitus and cardiovascular disease (p< 0.05). Compared with the control group, mean 24h systolic BP (SBP), mean daytime SBP (DSBP), and mean nocturnal SBP (NSBP) were greater in the WMLs group, and 24hSBPSD, DSBPSD, DDBPSD, and NSBPSD were greater in the WMLs group (p< 0.05). The circadian rhythms were significantly different between the WMLs group and the control group (p< 0.05). Age, non-dipper, and antidipper pattern were found to be independent risk factors for WMLs. Multivariate logistic regression revealed that age (OR 1.128 CI 1.082– 1.175, p< 0.001) and the non-dipper pattern (OR 4.855 CI 1.062– 22.184, p=0.042) were independent risk factors for WMLs.
Conclusion: Age and non-dipper and antidipper patterns are associated with an increased risk of WMLs. Non-dipper BP is an independent risk factor for WMLs. Middle-aged and elderly people with primary hypertension with non-dipper BP need to manage and control nocturnal BP.

Keywords: white matter lesions, ambulatory blood pressure monitoring, blood pressure variability, circadian rhythm of blood pressure, blood pressure at night