Pitfalls to avoid in the measurement of blood pressure in the elderly

Accurate, reproducible blood pressure readings are more difficult to obtain in the elderly. Elderly patients have more variable blood pressure, show a reduction in blood pressure following meals, and can have postural hypotension, discrepancies in blood pressure between arms, auscultatory gaps and 'pseudohypertension', all of which can mislead clinicians regarding these patients' usual blood pressure. Arrhythmias, particularly atrial fibrillation, make accurate blood pressure determination difficult and are more common in the elderly. Prostatic hypertrophy causing high pressure urinary retention is suggested as a common and reversible cause of hypertension in older men. Proper measurement of blood pressure in elderly patients demands additional thought and action, all of which are necessary for accurate cardiovascular risk assessment and proper therapeutic decisions. Increasing the number of visits and the number of carefully taken blood pressure readings per visit will result in a more accurate assessment of blood pressure in older patients.