BACKGROUND: Masked diastolic hypotension is a new blood pressure (BP) pattern detected by ambulatory blood pressure monitoring (ABPM) in elderly hypertensives. The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic. METHODS: Comorbidity was assessed by Charlson comorbidity index (CCI) and CHA2DS2VASc score. All subjects evaluated with ABPM were aged ≥ 65 years. CCI and CHA2DS2VASc score were calculated. Diastolic hypotension was defined as mean ambulatory diastolic BP < 65 mmHg and logistic regression analysis was carried out in order to detect and independent relationship between comorbidity burden and night-time diastolic BP < 65 mmHg. RESULTS: We studied 174 hypertensive elderly patients aged 72.1 ± 5.2 years, men were 93 (53.4%). Mean CCI was 0.91 ± 1.14 and mean CHA2DS2VASc score of 2.68 ± 1.22. Subjects with night-time mean diastolic values < 65 mmHg were higher in females [54.7% vs. 45.3%, P = 0.048; odds ratio (OR) = 1.914, 95% CI: 1.047-3.500]. Logistic regression analysis showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic values < 65 mmHg (OR = 1.518, 95% CI: 1.161-1.985; P = 0.002), but CCI was not. CONCLUSIONS: ABPM and comorbidity evaluation appear associated in elderly fit subjects with masked hypotension. Comorbid women appear to have higher risk for low ambulatory BP.
Ambulatory blood pressure monitoring (ABPM) is now considered by current guidelines to be a reliable method of measurement for the diagnosis and assessment of hypertension. The aim of this study was to relate the short-term outcomes, comorbidity and ABPM findings determined from evaluating an everyday clinical cohort of hypertensive patients. A prospective study was carried out that included hypertensive patients who had undergone 24-h ABPM from January 2016 to November 2017. The following parameters were recorded in the database: age, sex, current antihypertensive treatment and documented history of comorbidities. New episodes of myocardial infarction and stroke requiring hospitalization during follow-up obtained from electronic medical records were considered to be major adverse cardiovascular events (MACE) and were our main outcome measures. To estimate the risk of MACE, a Cox multivariate analysis was carried out. We analysed 1521 ABPM values and recorded 33 MACE during a follow-up of 518±120 days; 15 patients suffered a myocardial infarction and 18 patients had a stroke. The mean age of the patients was 59.9±14.2 years, and 49.4% were men. Night-time systolic blood pressure (BP), mean BP and pulse pressure were higher in patients who suffered a MACE. Age [hazard ratio (HR): 1.031, 95% confidence interval (CI): 1.002-1.060; P=0.036], night-time BP (HR: 1.018, 95% CI: 1.001-1.037; P=0.044) and diabetes mellitus (HR: 2.393, 95% CI: 1.053-5.436; P=0.037) were associated independently with MACE. We conclude that night-time BP is an important parameter to evaluate in aged patients with diabetes as a predictor of MACE.
Arterial Pressure , Blood Pressure Monitoring, Ambulatory/methods , Circadian Rhythm , Hypertension/diagnosis , Age Factors , Aged , Antihypertensive Agents/therapeutic use , Cohort Studies , Comorbidity , Diabetes Mellitus/epidemiology , Female , Hospitalization , Humans , Hypertension/epidemiology , Male , Middle Aged , Prognosis , Proportional Hazards Models , Prospective Studies , Risk Factors , Sex Factors , Time Factors
