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Factors Associated With Discordant Blood Pressure Measures among Very Old Adults: Results From the Atherosclerosis
Fredrick Larbi Kwapong1, Benjamin Grobman1, Hannah Col1
1Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.L.K., B.G., H.C., M.M.K., D.P., E.L.A., M.Z., R.-A.N.T.-O., L.N., J.L.C., K.M., S.P.J.).
Insights
Home blood pressure monitoring (HBPM) shows significant differences compared to office BP in very old adults. Factors like higher BP, male sex, and smaller arm circumference influence these discrepancies.
Area of Science:
- Gerontology
- Cardiovascular Health
- Clinical Measurement
Background:
- Home blood pressure monitoring (HBPM) is a growing alternative to traditional office blood pressure (BP) measurements.
- Understanding the factors affecting agreement between office and home BP is crucial, especially in the very old adult population.
Purpose of the Study:
- To investigate the factors influencing the agreement between automated office blood pressure (AOBP) and home blood pressure monitoring (HBPM) in very old adults.
- To identify demographic, anthropometric, and clinical predictors of discordance between AOBP and HBPM.
Main Methods:
- The study involved 792 participants (mean age 84 years) from the Atherosclerosis Risk in Communities (ARIC) study.
- Automated office BP (AOBP) was measured using an Omron HEM-907XL, and HBPM was performed twice daily for 8 days using an Omron BP7450.
- Discordance was defined as a systolic BP difference of ±10 mm Hg between mean AOBP and HBPM. Multivariable regression models were used to analyze associated factors.
Main Results:
- Despite a small average difference (1.0±15.7 mm Hg), 49% of participants showed a systolic BP discordance of ≥10 mm Hg.
- Higher AOBP, male sex, smaller arm circumference, and frailty were associated with increased discordance.
- Elevated baseline AOBP (≥140 mm Hg) strongly predicted significant discordance, and older age groups (91-100 years) had lower AOBP compared to younger ones (78-80 years).
Conclusions:
- Substantial blood pressure discordance between AOBP and HBPM is common in very old adults.
- Key influencing factors include higher BP readings, advanced age, male sex, smaller arm circumference, and frailty.
- These findings highlight the complexity of BP measurement agreement in geriatric populations and the need for careful interpretation.
Background:
Home blood pressure (BP) monitoring (HBPM) is increasingly used as an alternative to office BP. However, factors influencing agreement between office and home BP among very old adults remain unclear.
Methods:
During ARIC (Atherosclerosis Risk in Communities) visit 10, participants underwent 3 automated office BP (AOBP) measurements using an Omron HEM-907XL and performed HBPM twice daily for 8 days using an Omron BP7450. Discordance was defined as a systolic BP difference of ±10 mm Hg between mean AOBP and HBPM. Multivariable regression models evaluated demographic, anthropometric, and clinical factors associated with discordance.
Results:
Among 792 participants (58% female; mean age, 84±3.7 years), mean systolic BP was 130.6 mm Hg (AOBP) and 129.6 mm Hg (HBPM). Despite a minimal average difference (1.0±15.7 mm Hg), 49% had ≥10 mm Hg systolic BP discordance. Higher AOBP was associated with greater discordance. Compared with females, males had lower AOBP relative to HBPM (-4.69 mm Hg [95% CI, -6.86 to -2.51]). Smaller arm circumference was associated with higher discordance (β=14.4 mm Hg [95% CI, 4.78-24.04]). Frail adults had lower AOBP relative to HBPM (β, -5.1 mm Hg [95% CI, -11.0 to 0.9]). Baseline AOBP systolic BP ≥140 mm Hg strongly predicted discordance ≥+10 mm Hg (odds ratio, 8.27 [95% CI, 5.52-12.40]). Participants aged 91 to 100 years had lower AOBP than those aged 78 to 80 years (β, -5.0 mm Hg [95% CI, -10.06 to 0.001]).
Conclusions:
Among very old adults, substantial BP discordance between AOBP and HBPM was common and influenced by higher BP, age, male sex, arm circumference, and frailty.
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