BACKGROUNDSeveral clinical studies have shown that blood pressure (BP) measurements in very old frail individuals are of limited interest due to the fact that several age-related alterations and geriatric syndromes may modify BP. We studied in persons over 80-year old living in nursing homes the combined effects of 3 BP patterns on total mortality and major cardiovascular (CV) events: (i) low pulse pressure amplification (L-PPA) between carotid and brachial artery, (ii) systolic BP (SBP) < 130 mm Hg (L-SBP), under > 1 antihypertensive drugs, and (iii) changes in SBP between supine and upright position of > 20 mm Hg in both directions (hypotension/hypertension, orthostatic SBP [O-SBP]).METHODSThis analysis was performed in subjects of the PARTAGE study presenting all these 3 measurements (n = 883). The combined effects of L-PPA, L-SBP, and O-SBP were studied during the 2 years followed-up period.RESULTSAfter adjusting for age, sex, and history of CV events, all 3 BP patterns were independent determinants of major CV events (L-PPA, (P = 0.023); SBP, (P = 0.050); O-SBP, (P = 0.015)), whereas L-PPA (P = 0.012) and L-SBP (P = 0.006) were also independent determinants of total mortality. Compared with the subjects without any BP pattern, the presence of 2 or 3 BP patterns was associated with an increase in total mortality and major CV events greater than 2 and 2.5 times, respectively.CONCLUSIONSIn very old frail subjects, there is a particular interest for using different BP measurement approaches, than in younger populations, in order to evaluate the risks related to the BP levels.

Interest of Combined Blood Pressure Measurements in Very Old Frail Subjects: The PARTAGE Study

Valbusa, F;Fantin, F;
2018

Abstract

BACKGROUNDSeveral clinical studies have shown that blood pressure (BP) measurements in very old frail individuals are of limited interest due to the fact that several age-related alterations and geriatric syndromes may modify BP. We studied in persons over 80-year old living in nursing homes the combined effects of 3 BP patterns on total mortality and major cardiovascular (CV) events: (i) low pulse pressure amplification (L-PPA) between carotid and brachial artery, (ii) systolic BP (SBP) < 130 mm Hg (L-SBP), under > 1 antihypertensive drugs, and (iii) changes in SBP between supine and upright position of > 20 mm Hg in both directions (hypotension/hypertension, orthostatic SBP [O-SBP]).METHODSThis analysis was performed in subjects of the PARTAGE study presenting all these 3 measurements (n = 883). The combined effects of L-PPA, L-SBP, and O-SBP were studied during the 2 years followed-up period.RESULTSAfter adjusting for age, sex, and history of CV events, all 3 BP patterns were independent determinants of major CV events (L-PPA, (P = 0.023); SBP, (P = 0.050); O-SBP, (P = 0.015)), whereas L-PPA (P = 0.012) and L-SBP (P = 0.006) were also independent determinants of total mortality. Compared with the subjects without any BP pattern, the presence of 2 or 3 BP patterns was associated with an increase in total mortality and major CV events greater than 2 and 2.5 times, respectively.CONCLUSIONSIn very old frail subjects, there is a particular interest for using different BP measurement approaches, than in younger populations, in order to evaluate the risks related to the BP levels.
frailty
pulse pressure amplification
blood pressure
mortality
orthostatic hypertension
Antihypertensive Drugs
orthiostatic hypotension
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1020607
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