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The value of ambulatory blood pressure in older adults: the Dublin outcome study

Marian L Burr1, Eamon Dolan, Eoin W O'Brien

  • 1The Lewin Stroke and Rehabilitation Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, UK. marianlburr@doctors.org.uk

Age and Ageing
|March 20, 2008
PubMed

Insights

Ambulatory blood pressure (ABPM) monitoring is a superior predictor of cardiovascular mortality in older adults compared to traditional clinic blood pressure (BP) measurements. Night-time ABPM readings are the strongest indicator of adverse outcomes in this demographic.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Hypertension Research

Background:

  • Ambulatory blood pressure (ABPM) monitoring is recognized as a more accurate predictor of cardiovascular outcomes than clinic blood pressure (BP) in younger populations.
  • The clinical utility of ABPM in predicting mortality in elderly individuals remains an area of active investigation.

Purpose of the Study:

  • To investigate whether ABPM predicts total and cardiovascular mortality independently of clinic BP and other cardiovascular risk factors in individuals aged 65 and older.
  • To assess the predictive value of different ABPM parameters for mortality in the elderly population.

Main Methods:

  • A cohort of 1144 individuals aged 65 and over underwent 24-hour ABPM and clinic BP measurements at baseline.
  • The study followed participants for a mean of 6.7 years, recording 385 deaths, including 246 cardiovascular deaths.

Main Results:

  • Elevated mean ABPM values independently predicted cardiovascular mortality, even after adjusting for clinic BP, gender, age, and risk indices.
  • Each 10-mmHg increase in daytime systolic BP (SBP) increased hazard ratio by 1.10, and night-time SBP by 1.18.
  • Each 5-mmHg increase in daytime diastolic BP (DBP) increased hazard ratio by 1.05, and night-time DBP by 1.09.
  • Night-time ABPM remained a significant predictor of mortality even after adjustment for daytime ABPM.

Conclusions:

  • Ambulatory blood pressure measurement is superior to clinic BP measurement for predicting cardiovascular mortality in elderly subjects.
  • Night-time blood pressure, as measured by ABPM, emerges as the most potent predictor of adverse cardiovascular outcomes in this age group.
Abstract

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