Detection of blood pressure increments in active elderly individuals: the role of ambulatory blood pressure monitoring

Blood Pressure Control in Elderly Chronic Kidney Disease Patients

In elderly chronic kidney disease (CKD) patients, isolated systolic hypertension is common, the rate of renal function decline is slow, and there is a high possibility of physical damage due to side effects such as drug use-related orthostatic hypotension. Therefore, there are still many questions about whether lowering blood pressure in elderly patients will actually improve prognosis. Since many blood pressure-related clinical studies exclude advanced CKD and the elderly, it is particularly difficult to define target blood pressure in these populations. A randomized controlled trial is needed to establish optimal blood pressure targets and treatment strategies in elderly patients with CKD. This review seeks to summarize the guidelines available at this time.

Ten-year changes in ambulatory blood pressure: The prognostic value of ambulatory pulse pressure

Blood pressure (BP) changes and risk factors associated with pulse pressure (PP) increase in elderly people have rarely been studied using ambulatory blood pressure monitoring (ABPM). The aim is to evaluate 10-year ambulatory blood pressure (ABP) changes in older hypertensives, focusing on PP and its associations with mortality. An observational study was conducted on 119 consecutive older treated hypertensives evaluated at baseline (T0) and after 10 years (T1). Treatment adherence was carefully assessed. The authors considered clinical parameters at T1 only in survivors (n = 87). Patients with controlled ABP both at T0 and T1 were considered as having sustained BP control. Change in 24-hour PP between T0 and T1 (Δ24-hour PP) was considered for the analyses. Mean age at T0: 69.4 ± 3.7 years. Females: 57.5%. Significant decrease in 24-hour, daytime, and nighttime diastolic BP (all P < .05) coupled with an increase in 24-hour, daytime, and nighttime PP (all P < .05) were observed at T1. Sustained daytime BP control was associated with lower 24-hour PP increase than nonsustained daytime BP control (+2.23 ± 9.36 vs +7.79 ± 8.64 mm Hg; P = .037). The association between sustained daytime BP control and Δ24-hour PP remained significant even after adjusting for age, sex, and 24-hour PP at T0 (β=0.39; P = .035). Both 24-hour systolic BP and 24-hour PP at T0 predicted mortality (adjusted HR 1.07, P = .001; adjusted HR 1.25, P < .001, respectively). After ROC comparison (P = .001), 24-hour PP better predicted mortality than 24-hour systolic BP. The data confirm how ABP control affects vascular aging leading to PP increase. Both ambulatory PP and systolic BP rather than diastolic BP predict mortality in older treated hypertensives.

Prevalence, risk factors, and prognostic significance of masked hypertension in diabetic patients

The aims of present study were to evaluate the prevalence, risk factors, and prognostic significance of masked hypertension in diabetic patients. Using a cross-sectional design, 266 patients with documented type 2 diabetes mellitus and clinic blood pressure (BP) <140/90 mm Hg without antihypertension treatment were enrolled; 24-hour ambulatory BP monitoring was applied to evaluate mean 24-hour systolic/diastolic BP. Demographics, medical histories, and medications usage were obtained using questionnaire. Fasting venous blood was drawn for biochemical analysis. Approximately 26.5% of participants were diagnosed as masked hypertension with mean 24-hour systolic BP >130 mm Hg and/or mean 24-hour diastolic BP >80 mm Hg. Compared with those without masked hypertension, other than significantly higher mean 24-hour systolic/diastolic BP, patients with masked hypertension were more elderly, had higher serum glycated hemoglobin (HbA1c) and C-reactive protein (CRP) levels and higher prevalence of coronary heart disease (CHD). Multivariate regression analysis showed that aging, increased HbA1c and CRP levels, and prevalent CHD were independently associated with masked hypertension. Logistic regression analysis revealed that after adjusted for traditional risk factors including age, male sex, smoking status, low-density lipoprotein-cholesterol, CRP, clinic systolic BP, and HbA1c, masked hypertension remained independently associated with prevalent cardiovascular disease (CVD), with odds ratio of 1.31 and 95% confidence interval of 1.11 to 1.85. In summary, in diabetic patients, concurrent masked hypertension increases the odds of having CVD. Future randomized controlled trials are warranted to investigate whether screening and managing masked hypertension could reduce cardiovascular events in diabetic patients.

Ambulatory blood pressure monitoring in the elderly: features and perspectives

Aging leads to a multitude of changes in the cardiovascular system that include a rise in blood pressure. Age-related changes in blood pressure are mainly attributable to an increase in systolic blood pressure, generally associated with a slight decrease diastolic blood pressure. This leads to a widening in pulse pressure. Ambulatory blood pressure monitoring is a useful tool to understand these processes and to refine cardiovascular risk assessment. In the light of emerging data in this area, we reviewed the main features of ambulatory blood pressure in elderly and discussed the evidence showing that ambulatory blood pressure is superior to clinic blood pressure to reflect the true pattern of blood pressure over time. Furthermore, we discussed the role of weight control obtained by fitness programs to prevent an excessive rise in blood pressure with age. A thorough understanding of these concepts is of paramount importance and has therapeutic implications in the growing population of elderly subjects with increased blood pressure.