Ambulatory blood pressure monitoring in older nursing home residents: diagnostic and prognostic role.
BACKGROUND
Older subjects living in nursing homes (NHs) show a high prevalence of multimorbidity, disability, and cognitive impairment. The clinical meaning of arterial hypertension (AH) in this population is unclear, and few studies have adopted ambulatory blood pressure monitoring (ABPM) with this purpose. The aims of the study were to evaluate the concordance between office and monitored blood pressure in a sample of NH residents and to assess the prognostic meaning of ABPM parameters after 1 year.


METHODS
NH residents underwent a comprehensive geriatric assessment and 24-hour ABPM (Spacelabs 90207). White-coat hypertension (WCH) was defined as office blood pressure of 140/90 or higher and ABPM lower than 135/85 mm Hg. Vital status was assessed after 1 year.


RESULTS
A total of 100 residents (mean age 83, 51% affected by AH) showed WCH in 33% of cases and in 70% of cases elevated office blood pressure. Correlation between monitored and office blood pressure was limited for systolic (R = 0.30) and nonsignificant for diastolic blood pressure (R = 0.11). Disability and behavioral disorders were independently associated with 1-year mortality. No ABPM parameter, except low nighttime systolic blood pressure variability, was associated with 1-year mortality.


CONCLUSIONS
Concordance between office and ABPM values is limited, and WCH prevalence is high among NH residents. Survival at 1-year follow-up is predicted by disability and behavioral disorders, but is not associated with blood pressure values.
Division of Geriatric Medicine and Cardiology, University of Florence and Careggi Teaching Hospital, Florence, Italy. enrico.mossello@unifi.it
Enrico
E
Mossello
Maria Chiara
MC
Pieraccioli
Samanta
S
Zanieri
Angela
A
Fedeli
Maddalena
M
Belladonna
Nicola
N
Nesti
Niccolò
N
Marchionni
Giulio
G
Masotti
Andrea
A
Ungar
D000368:Aged; D000369:Aged, 80 and over; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D007558:Italy; D008297:Male; D009735:Nursing Homes; D036301:Qualitative Research; D016019:Survival Analysis