Objective To investigate the correlation between diurnal fluctuation of blood pressure and intracranial atherosclerotic plaque characteristics, including the atherosclerotic plaque burden
and its vulnerability.
Methods The clinical and imaging data of 267 stroke patients from an intracranial
atherosclerotic stroke imaging cohort were included in this retrospective analysis. According to
24-hour ambulatory blood pressure fluctuation rhythm, the patients were divided as dipper, nondipper, and reverse-dipper groups. High resolution MR vessel wall imaging was used to evaluate
atherosclerotic plaque burden and its vulnerability. The intracranial atherosclerotic plaque
characteristics including maximum vessel wall thickness (maxWT), intraplaque hemorrhage
(IPH), moderate-severe stenosis (≥50%), multiple plaques (≥3 plaques) and etc. Baseline
characteristics and plaque characteristics were compared among three groups, and multivariate
logistic regression analysis was used to determine the association between diurnal fluctuation
pattern of blood pressure and intracranial plaque burden and vulnerability.
Results There were 36, 119 and 112 patients in the dipper, non-dipper, and reverse-dipper groups,
respectively. (1) The age was the eldest (the mean age: 67.3, 64.6, and 61.9 years old in reversedipper, non-dipper and dipper groups, respectively, P=0.042), the proportion of diabetes was the
highest (46.4%, 41.2%, and 22.2% in reverse-dipper, non-dipper and dipper groups, respectively,
P=0.037), and the mean 24-hour systolic blood pressure was the highest (144 mmHg in reversedipper group, 139 mmHg in non-dipper group, and 136 mmHg in dipper groups, respectively,
P=0.025) in the reverse-dipper group among the three groups; (2) The plaque characteristics
in dipper, non-dipper, and reverse-dipper groups were as follows: the maxWT was 2.39 mm,
2.48 mm and 2.52 mm, P=0.554; the prevalence of IPH was 33.3% (12/36), 36.1% (43/119) and
37.5% (42/112), P=0.901; the proportion of moderate-severe stenosis of large intracranial artery
was 22.2%, 32.8%, and 37.5%, P=0.236, and the proportion of multiple plaques was 63.9%,
73.9%, and 75.0%, P=0.407; (3) the multivariate logistic regression analysis showed that elder age
(OR 1.053, 95%CI 1.027-1.080, P<0.001) and diabetes (OR 2.194, 95%CI 1.186-4.057, P=0.012)
were correlated with multiple intracranial plaques, diurnal fluctuation pattern of blood pressure
was no correlated with intracranial plaque burden (multiple plaques) and vulnerability (IPH), and
moderate-severe stenosis of large intracranial artery (all P>0.05).
Conclusions The increasing age and diabetes were independent predictors of multiple
intracranial plaques, and the diurnal fluctuation pattern of blood pressure was no correlated with
intracranial atherosclerotic plaque burden and vulnerability.
