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Long-term reproducibility of ambulatory blood pressure is superior to office blood pressure in the very elderly

Journal of Human Hypertension volume 24, pages 749–754 (2010)Cite this article

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Abstract

Although it is known that reproducibility of ambulatory blood pressure (BP) is superior to office BP in middle-aged subjects, little is known in older age groups. Hence, we compared the long-term reproducibility of ambulatory and office BP readings in subjects over the age of 75 years. A cohort of 72 subjects 75–90 years of age (mean, 82 years at baseline) had repeat office and ambulatory BPs 2 years apart under similar conditions. On the same day, patients underwent office BP measurements by a semi-automated device and then by ambulatory BP monitoring. Awake and sleep periods were divided according to a diary kept by each patient. The agreement between studies was assessed using the standard deviation of the differences (SDD) and Bland–Altman plots. There were minimal mean changes in office, 24-h, and awake and sleep mean BP values between baseline and 2 years later. The SDDs between visits were lower for 24-h BP compared with the office BP (11.7/5.9 mm Hg versus 17.8/9.0 mm Hg, P<0.01). The SDD for 24-h BP was also lower than the SDDs for the awake and sleep BP (P<0.05). Nocturnal BPs defined by absolute values were more reproducible than categories of dippers and non-dippers. These data demonstrate that long-term reproducibility of 24-h BP is superior to office measurements for very elderly subjects. In a clinical trial involving this age group, far fewer subjects would be required if 24-h BP was the primary efficacy endpoint rather than the office BP.

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References

  1. Trazzi S, Mutti E, Frattola A, Imholz B, Parati G, Mancia G . Reproducibility of non-invasive and intra-arterial blood pressure monitoring: implications for studies on antihypertensive treatment. J Hypertens 1991; 9: 115–119.

    Article  CAS  PubMed  Google Scholar 

  2. Des Combes BJ, Porchet M, Waeber B, Brunner HR . Ambulatory blood pressure recordings reproducibility and unpredictability. Hypertension 1984; 6: 110–114.

    Article  CAS  PubMed  Google Scholar 

  3. James GD, Pickering TG, Yee LS, Harshfield GA, Riva S, Laragh JH . The reproducibility of average ambulatory, home and clinic pressures. Hypertension 1988; 11: 545–549.

    Article  CAS  PubMed  Google Scholar 

  4. Conway J, Johnston J, Coats A, Somers V, Sleight P . The use of ambulatory blood pressure monitoring to improve the accuracy and reduce the numbers of subjects in clinical trials of antihypertensive agents. J Hypertens 1988; 6: 111–116.

    Article  CAS  Google Scholar 

  5. Mansoor GA, McCabe EJ, White WB . Long-term reproducibility of ambulatory blood pressure. J Hypertens 1994; 12: 703–708.

    Article  CAS  Google Scholar 

  6. Wizner B, Dechering DG, Thijs L, Atkins N, Fagard R, O’Brien E et al. Short-term and long-term repeatability of the morning blood pressure in older patients with isolated systolic hypertension. J Hypertens 2008; 26: 1328–1335.

    Article  CAS  PubMed  Google Scholar 

  7. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887–1898.

    Article  CAS  Google Scholar 

  8. Burr ML, Dolan E, O’Brien EW, O’Brien ET, McCormack P . The value of ambulatory blood pressure in older adults: the Dublin outcome study. Age Ageing 2008; 37: 201–206.

    Article  PubMed  Google Scholar 

  9. Staessen JA, Thijs L, Fagard R, O’Brien ET, Clement D, de Leeuw PW et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. JAMA 1999; 282: 539–546.

    Article  CAS  Google Scholar 

  10. Bjorklund K, Lind L, Zethelius B, Berglund L, Lithell H . Prognostic significance of 24-h ambulatory blood pressure characteristics for cardiovascular morbidity in a population of elderly men. J Hypertens 2004; 22: 1691–1697.

    Article  PubMed  Google Scholar 

  11. Khattar RS, Swales JD, Dore C, Senior R, Lahiri A . Effect of aging on the prognostic significance of ambulatory systolic, diastolic and pulse pressure in essential hypertension. Circulation 2001; 104: 783–789.

    Article  CAS  Google Scholar 

  12. Moscufo N, Guttmann CR, Meier D, Csapo I, Hildenbrand PG, Healy BC et al. Brain regional lesion burden and impaired mobility in the elderly. Neurobiol Aging 2009 (e-pub ahead of print).

  13. Goodwin J, Bilous M, Winship S, Finn P, Jones SC . Validation of the Oscar 2 oscillometric 24-h ambulatory blood pressure monitor according to the British Hypertension Society protocol. Blood Pressure Monit 2007; 12: 113–117.

    Article  Google Scholar 

  14. Bland JM, Altman DG . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–311.

    Article  CAS  Google Scholar 

  15. Pitman EJG . A note on normal correlation. Biometrika 1939; 31: 9–12.

    Article  Google Scholar 

  16. White WB, Larocca G . Improving the utility of the nocturnal hypertension definition by using absolute sleep blood pressure rather than the ‘Dipping’ proportion. Am J Cardiol 2003; 92: 1439–1441.

    Article  Google Scholar 

  17. Palatini P, Mormino P, Canali C, Santonastaso M, De Venuto G, Zanata G et al. Factors affecting ambulatory blood pressure reproducibility: Results of the HARVEST Trial. Hypertension 1994; 23: 211–216.

    Article  CAS  Google Scholar 

  18. Kario K, Ishikawa J, Pickering TG, Hoshide S, Eguchi K, Morinari M et al. Morning hypertension: the strongest independent risk factor for stroke in elderly hypertensive patients. Hypertens Res 2006; 29: 581–587.

    Article  PubMed  Google Scholar 

  19. Metoki H, Ohkubo T, Kikuya M, Asayama K, Obara T, Hara A et al. Prognostic significance of night-time, early morning and daytime blood pressures on the risk of cerebrovascular mortality: the Ohasama Study. J Hypertens 2006; 24: 1841–1848.

    Article  CAS  PubMed  Google Scholar 

  20. Omboni S, Parati G, Palatini P, Vanasia A, Muiesan ML, Cuspidi C et al. Reproducibility and clinical value of nocturnal hypotension: prospective evidence from the SAMPLE study. J Hypertens 1998; 16: 733–738.

    Article  CAS  Google Scholar 

  21. Cuspidi C, Meani S, Valerio C, Sala C, Fusi V, Masaidi M et al. Reproducibility of dipping/non-dipping pattern in untreated essential hypertensive patients: impact of sex and age. Blood Press Monit 2007; 12: 101–106.

    Article  Google Scholar 

  22. Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Quarti Trevano F et al. Long-term prognostic value of blood pressure variability in the general population: Results of the Pressioni Arteriose Monitirate e Loro Associazioni Study. Hypertension 2007; 49: 1265–1270.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was funded by NIH RO1 AG022092, NIH 5R01 DA24667-2 and the University of Connecticut Clinical Trials Unit.

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Authors and Affiliations

  1. Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA

    P Campbell, N Ghuman & W B White

  2. Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA

    D Wakefield & L Wolfson

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  1. P Campbell
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  2. N Ghuman
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Correspondence to W B White.

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Campbell, P., Ghuman, N., Wakefield, D. et al. Long-term reproducibility of ambulatory blood pressure is superior to office blood pressure in the very elderly. J Hum Hypertens 24, 749–754 (2010). https://doi.org/10.1038/jhh.2010.8

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