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Circadian blood pressure patterns in ambulatory hypertensive patients: effects of age
Insights
Age significantly impacts blood pressure patterns and variability. Ambulatory circadian blood pressure monitoring reveals changes in older hypertensive patients that casual measurements miss.
Area of Science:
- Cardiology
- Gerontology
- Hypertension Research
Background:
- Circadian blood pressure monitoring is crucial for understanding hypertension.
- Age influences cardiovascular patterns, including blood pressure and heart rate.
- Casual blood pressure measurements may not fully represent 24-hour patterns, especially in older adults.
Purpose of the Study:
- To investigate the effects of age on blood pressure and heart rate patterns and variability.
- To compare casual blood pressure readings with 24-hour ambulatory monitoring in hypertensive patients.
- To assess how age influences the correlation between casual and average blood pressure.
Main Methods:
- Ambulatory circadian blood pressure monitoring over 24 hours in 50 untreated hypertensive patients.
- Patients were divided into younger (<55 years) and older (≥55 years) groups.
- Analysis of blood pressure and heart rate patterns, variability, and correlations with casual measurements.
Main Results:
- Casual systolic and diastolic blood pressure were higher than 24-hour averages.
- Correlations between casual and average blood pressure were stronger in younger patients.
- Systolic blood pressure variability increased with age; diastolic variability showed a non-significant trend.
- Older patients exhibited higher systolic pressure levels and lower diastolic pressure and heart rate levels.
Conclusions:
- Ambulatory circadian blood pressure monitoring reveals age-related changes in blood pressure levels and variability.
- Casual blood pressure measurements are insufficient for accurately assessing hypertension in the elderly.
- Extended blood pressure monitoring is necessary for characterizing hypertension in older individuals.
Abstract:
Circadian blood pressure monitoring was performed in 50 untreated ambulatory hypertensive patients to study the effects of age on the pattern and variability of blood pressure and heart rate. Casual blood pressure, measured in the morning, was greater than the average of the blood pressures measured at 7.5 minute intervals for 24 hours (148 +/- 2/95 +/- 2 and 137 +/- 2/88 +/- 2 mm Hg, p less than 0.001). The correlation between casual systolic pressure and the 24 hour average was stronger (p less than 0.05) in younger (less than 55 years of age) patients (r = 0.69, n = 24, p less than 0.001) than in older patients (r = 0.42, n = 26, p less than 0.1). Similarly, diastolic pressures correlated more strongly (p less than 0.05) in younger patients (r = 0.71, p less than 0.001) than in older patients (r = 0.43, p less than 0.05). Variability of systolic pressure, defined as the standard deviation of all readings obtained during 24 hours, was greater than that of diastolic pressure (16.7 and 13.1 mm Hg, respectively, p less than 0.001). Moreover, the variability of systolic pressure was greater in older than in younger patients (18.1 and 15.2 mm Hg, respectively, p less than 0.01). The variability of diastolic pressure was slightly but not significantly greater in older patients (13.7 and 12.5 mm Hg, not significant). The circadian pattern of blood pressure, expressed as averages of readings obtained during consecutive 2 hour intervals, was similar in the two age groups. However, the level of systolic pressure was consistently higher (p less than 0.01) and that of both diastolic pressure and heart rate consistently lower (p less than 0.01) in older patients. Thus, ambulatory circadian blood pressure monitoring reveals significant changes in blood pressure levels and its variability with age; the casual blood pressure does not accurately reflect these changes. Longer periods of blood pressure monitoring are required for accurate assessment of the characteristics of hypertension in the aged.