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Prevalence of office and ambulatory hypotension in treated hypertensive patients with coronary disease

Hypertension Research volume 43, pages 696–704 (2020)Cite this article

Abstract

Patients with coronary heart disease (CHD) can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. This study estimated the prevalence of hypotension among CHD-treated hypertensive patients undergoing ambulatory blood pressure monitoring (ABPM) in routine clinical practice. We performed a cross-sectional study with 2892 CHD-treated hypertensive patients from the Spanish ABPM Registry. Based on previous studies, hypotension was defined as systolic/diastolic BP < 120 and/or 70 mmHg according to office measurements, <115 and/or 65 mmHg according to daytime ABPM, <100 and/or 50 mmHg according to nighttime ABPM, and <110 and/or 60 mmHg according to 24 h ABPM. The participants’ mean age was 67.1 years (69.8% men). A total of 19.6% of the patients had office hypotension, 26.5% had daytime hypotension, 9.0% had nighttime hypotension, and 16.1% had 24-hr ABPM hypotension. Low diastolic BP values were responsible for most cases of hypotension. Fifty-eight percent of the cases of hypotension detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently associated with daytime ambulatory systolic/diastolic hypotension and diastolic hypotension (the latter being the most frequent type of ambulatory hypotension) were age, female sex, and the number of antihypertensive medications. In conclusion, in a large ABPM registry, one out of every four CHD-treated hypertensive patients was potentially at risk because of hypotension according to daytime ABPM, and more than half of them were not identified if office BP was relied on alone. We suggest that ABPM should be performed in these patients.

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Funding

The Spanish ABPM Registry was initiated and is maintained by an unrestricted grant from Lacer Laboratories, Spain, and the Spanish Society of Hypertension. Specific funding for this analysis was obtained from Fondo de Investigación Sanitaria (FIS) (Instituto de Salud Carlos III and FEDER/FSE) grants PI16/01460, and Catedra de epidemiologia y control del riesgo cardiovascular (#820024). The funding agencies had no role in the study design; data collection, analysis, and interpretation; writing of the report; or the decision to submit it for publication.

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Authors and Affiliations

  1. Casas Ibáñez, Primary Care Center, Albacete, Spain

    Juan A. Divisón-Garrote

  2. Department of Medicine, Universidad Católica San Antonio, Murcia, Spain

    Juan A. Divisón-Garrote

  3. Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, IdiPAZ and CIBERESP, Madrid, Spain

    Juan J. de la Cruz & José R. Banegas

  4. Department of Internal Medicine, Hospital Mutua Terrassa, Universidad de Barcelona, Barcelona, Spain

    Alejandro de la Sierra

  5. La Mina Primary Care Center, Universidad de Barcelona, Barcelona, Spain

    Ernest Vinyoles

  6. Nephrology Department, Hospital Universitario Central de Asturias, RedinRed, Oviedo, Spain

    Manuel Gorostidi

  7. Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain

    Carlos Escobar-Cervantes

  8. Hypertension Unit, Nephrology Department, Hospital Doce de Octubre, Madrid, Spain

    Julián Segura

  9. Cardiology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

    Vivencio Barrios

  10. School of Doctoral Studies and Research, Instituto de Investigación Hospital Doce de Octubre, Universidad Europea de Madrid, Madrid, Spain

    Luis M. Ruilope

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  1. Juan A. Divisón-Garrote
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Correspondence to José R. Banegas.

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Divisón-Garrote, J.A., de la Cruz, J.J., de la Sierra, A. et al. Prevalence of office and ambulatory hypotension in treated hypertensive patients with coronary disease. Hypertens Res 43, 696–704 (2020). https://doi.org/10.1038/s41440-020-0462-9

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