Blood Pressure Measurements with Different Currently Available Methods in Elderly Hypertensive Hospitalized Patients:...

The reliability of blood pressure (BP) measurement in hospitalized patients is a topic of debate and the therapeutic implication of the routinely collected BP profiles is probably overestimated. When measurements are performed in elderly patients, further potential sources of misinterpretation occur.

We conducted a subanalysis of a previous study including 79 over 80-year-old hypertensive patients, hospitalized in an internal medicine ward. Five modalities of BP evaluations (measurement by physicians and nurses, self-measurement by patients, Finometer® beat-to-beat finger monitoring, and 24h monitoring) were analyzed, considering agreement and accuracy.

The mean (SD) age of the patients was 86.9±4.9 years (50% women). Patients' self-measurements of both systolic and diastolic BP (SBP and DBP) did not differ significantly from daytime 24-hour monitoring (D24hBPM) (mean difference -1.52, SE 1.71; p: ns and -0.58, SE 1.19 mmHg; p: ns). Conversely, SBP and DBP registered by nurses did significantly differ (mean difference -7.34, SE 1.42; p=0.007 and -4.7, SE 1.05 mmHg; p=0.003). SBP and DBP measured by patients also showed the better concordance, with lowest biases, and narrowest limits of agreements (LoA) and for SBP higher Kappa statistic values (bias 1.5, LoA -28.9 to 31.9; κ 0.563 and bias 0.6, LoA -20.4 to 21.5 mmHg; κ 0.412). The patients' sensitivity and specificity in predicting hypertensive systolic D24hBPM were 84.8% and 69.7%, respectively.

In elderly hospitalized patients an alternative to 24hBPM, self-measurements by patients offer the better agreement and reliability in detecting hypertensive values.