Total Atherosclerosis Burden of Baroreceptor-Resident Arteries Independently Predicts Blood Pressure Dipping in Patients With Ischemic Stroke

Abstract

Nighttime blood pressure (BP) generally dips by 10% to 20% of the daytime values, and abnormal BP dipping may affect vascular health independently of BP level. The regulation of BP dipping involves arterial baroreflex, whose receptors mainly reside in carotid sinuses and aortic arch. Atherosclerosis in these baroreceptor-resident arteries (BRAs) is frequent among patients with ischemic stroke (IS) and might impair their BP-regulating capacity. We aimed to examine associations between atherosclerosis of BRA and BP dipping in patients with IS. BP dipping ratio was measured by 24-hour ambulatory blood pressure monitoring on the sixth day after IS. With computed tomography angiography, atherosclerosis conditions in 10 segments of carotid sinuses and aortic arch were scored and summed as total atherosclerosis burden of BRA. Among the 245 patients with IS, 78.0% had atherosclerosis in BRA. The total AS burden of BRA was negatively correlated with systolic BP dipping ratio (r=-0.331; P<0.001) and diastolic BP dipping ratio (r=-0.225; P<0.001). After adjusting for age, sex, vascular risk factors, 24-hour BP means, cervical and intracranial atherosclerosis scores, the negative correlations still existed (adjusted β, -0.259 [95% CI, -0.416 to -0.102] and adjusted β, -0.178 [95% CI, -0.346 to -0.010], respectively). In conclusion, higher total atherosclerosis burden of BRA was independently indicative of more blunted dipping of systolic BP and diastolic BP in IS. The total atherosclerosis burden of BRA might be important for predicting and managing BP dipping in patients with IS.

Keywords: atherosclerosis; baroreceptor; baroreflex; blood pressure; carotid sinus; dipping; stroke.

Figure 1.

Measurements atherosclerosis (AS) burden of baroreceptor-resident arteries in patients with ischemic stroke. A, The measured segments of bilateral carotid sinuses included ① origin of internal carotid artery, ② carotid bifurcation, and ③ distal common carotid artery. B, The measured segments of aortic arch included ④ aortic arch, ⑤ origin of brachiocephalic trunk, ⑥ origin of left common carotid artery, and ⑦ origin of left subclavian artery. C, The long-tail arrow on the left indicated a distal common carotid artery with 25% to 49% vessel circumference affected by atherosclerosis, scored 2 points; the short-tail arrow on right indicated a carotid bifurcation with 50% to 74% vessel circumference affected by AS, scored 3 points. D, The long-tail arrow on the left and the short-tail arrow on right both indicated origins of internal carotid arteries with 50% to 74% vessel circumference affected by atherosclerosis, scored 3 points. E, The short-tail arrow indicated an aortic arch with 25% to 49% vessel circumference affected by AS, scored 2 points.

Figure 2.

Scatter plots of blood pressure dipping ratio and various atherosclerosis (AS) burden of baroreceptor-resident artery (BRA) indices in patients with ischemic stroke. DBP indicates diastolic blood pressure; and SBP, systolic blood pressure.