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Nocturnal Blood Pressure Dipping is Abolished in Old-Elderly Hospitalized Patients
Francesco Salvo1, Chiara Lonati2, Michele Berardi3
1Division of Internal Medicine, Poveri Infermi Hospital, Loc. San Bernardino, 4, 17073, Ceva, CN, Italy. fre1988s@gmail.com.
Introduction:
During sleep there is reduction of blood pressure (BP) caused by a decrease of the sympathetic nervous tone. This nocturnal "dipping" phenomenon, assessable with ambulatory blood pressure monitoring (ABPM), is blunted with increasing age.
Aim:
To assess the effect of hospitalization on night-time BP fall in old-elderly patients.
Methods:
We analysed 78 ABPM of old-elderly hospitalized patients (mean age 91 ± 0.5 years) and those of 18 outpatients as control group. The nocturnal BP fall was assessed calculating: the dipping value (DV) i.e. the difference between mean diurnal systolic BP (mDSBP) and mean nocturnal systolic BP (mNSBP) and the "dipping pattern" i.e. mNSBP/mDSBPx100.
Results:
Hospitalized patients showed a lower rate of normal dipping patterns (9 vs. 39%), an higher rate of reverse dippers (59 vs. 28%; p < 0.05) and a lower DV (-0.9 ± 1 vs. 9 ± 4 mmHg; p < 0.05) than patients of control group. At multivariate regression analysis including age, gender and hospitalization, DV was significantly correlated only with the hospitalization (β -0.3, t -2.9; p < 0.05).
Conclusions:
In old-elderly hospitalized patients nocturnal BP fall is abolished. This enhancement of the age related reduction of nocturnal BP dipping may be due to the stress associated with hospital environment.
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