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Ambulatory blood pressure monitoring in the elderly hypertensive patient
S Torriani1, B Waeber, A Petrillo
1Department of Hypertension, Universitaire Vaudois, Lausanne, Switzerland.
Insights
Ambulatory blood pressure monitoring helps identify elderly hypertensive patients with clinic-only high blood pressure. This tool aids in making informed therapeutic decisions for aged hypertensive individuals.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Diagnostics
Background:
- Elderly hypertensive patients often present with elevated blood pressure readings in clinical settings.
- Distinguishing between sustained hypertension and white-coat hypertension is crucial for appropriate management in older adults.
Purpose of the Study:
- To evaluate the utility of ambulatory blood pressure monitoring (ABPM) in elderly hypertensive patients.
- To determine if ABPM can accurately identify individuals with elevated blood pressure solely in a clinical environment.
Main Methods:
- A retrospective analysis was conducted on 69 hypertensive patients aged 70 years or older.
- Patients underwent ABPM using a portable semi-automatic blood pressure recorder during daily activities.
- Clinic blood pressure measurements were compared with ABPM readings.
Main Results:
- ABPM identified 17 untreated and 17 treated patients with sustained hypertension (≥160/90 mmHg), who showed significant blood pressure reduction after therapy adjustment.
- ABPM revealed 21 untreated and 14 treated patients with non-sustained hypertension (<160/90 mmHg), whose treatment remained unchanged.
- Office blood pressure decreased significantly in the non-sustained hypertension group without treatment modification.
Conclusions:
- Ambulatory blood pressure monitoring is valuable for elderly hypertensive patients.
- ABPM aids in identifying individuals with clinic-only hypertension, guiding therapeutic decisions.
- Out-of-clinic blood pressure profiles improve management strategies for aged hypertensive individuals.
Abstract:
In this retrospective analysis, we assessed the usefulness of ambulatory blood pressure monitoring in the evaluation of elderly hypertensive patients. Thirty-eight untreated and 31 treated hypertensives aged 70 years or more had a systolic blood pressure greater than or equal to 160 mmHg and/or a diastolic blood pressure greater than or equal to 95 mmHg in the clinic. All 69 patients underwent blood pressure monitoring during their customary daily activities using a portable semi-automatic blood pressure recorder (Remier M2000). The mean of all blood pressures obtained with this device was taken as the ambulatory recorded blood pressure. Recorded blood pressures were greater than or equal to 160 mmHg systolic and greater than or equal to 90 mmHg diastolic in 17 untreated and 17 treated patients. In these patients, the introduction of antihypertensive therapy, or its modification, markedly reduced blood pressure during a 4-8 month follow-up. A further 21 untreated and 14 treated patients had recorded blood pressures of less than 160/90 mmHg. The treatment status of these patients was left unchanged for 4-8 months of follow-up. Nevertheless, office blood pressure in these groups, with no change in treatment, decreased significantly during the observation period. At the last visit to the outpatient clinic, there was no significant difference in blood pressure between the four subgroups of patients. Thus, ambulatory blood pressure monitoring appears to be useful in the elderly hypertensive patient in detecting those patients whose blood pressure is elevated only in the clinic. Blood pressure profiles obtained outside the clinic may therefore be useful in making therapeutic decisions in the aged hypertensive.