title: Hypotension based on office and ambulatory monitoring blood pressure. Prevalence and clinical profile among a cohort of 70,997 treated hypertensives.
abstract: We aimed to determine the prevalence of hypotension and factors associated with the presence of this condition in treated hypertensive patients undergoing ambulatory blood pressure monitoring (ABPM). Data were taken from the Spanish ABPM Registry. Office blood pressure (BP) and ABPM were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as office systolic/diastolic BP <110 and/or 70 mm Hg, daytime ABPM <105 and/or 65 mm Hg, nighttime ABPM <90 and/or 50 mm Hg, and 24-hour ABPM <100 and/or 60 mm Hg. Multivariable logistic regression was performed to determine the variables associated with the presence of hypotension. A total of 70,997 hypertensive patients on treatment (mean age 61.8 years, 52.5% men) were included in the study. The prevalence of hypotension was 8.2% with office BP, 12.2% with daytime ABPM, 3.9% with nighttime ABPM, and 6.8% with 24-hour ABPM. Low diastolic BP values were responsible for the majority of cases of hypotension. Some 68% of the hypotension cases detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently and consistently associated with higher likelihood of office, daytime, and 24 hour-based hypotension were age, female gender, history of ischemic heart disease, and body mass index <30 kg/m(2) (P < .05). In conclusion, in this large cohort of patients in usual daily practice, one in eight treated hypertensive patients are at risk of hypotension according to daytime BP. Two-thirds of them are not adequately identified with office BP. ABPM could be especially helpful for identifying ambulatory hypotension, in particular in patients who are older, women, or with previous ischemic heart disease where antihypertensive treatment should be especially individualized and cautious.
authors.affiliation: Casas Ibáñez, Primary Care Center, Albacete, Spain; Medicine, Universidad Católica San Antonio, Murcia, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Divisón-Garrote
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, IdiPAZ, CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain. Electronic address: joseramon.banegas@uam.es.
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, IdiPAZ, CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: De la Cruz
authors.affiliation: Cardiology, Hospital La Paz, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Escobar-Cervantes
authors.affiliation: Department of Internal Medicine, Hospital Mutua Terrassa, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: De la Sierra
authors.affiliation: Nephrology Service, Hospital Universitario Central de Asturias, RedinRed, Oviedo, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gorostidi
authors.affiliation: La Mina Primary Care Center, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Ernest
authors.initials: E
authors.lastname: Vinyoles
authors.affiliation: San Andrés, Primary Care Center, Murcia, Spain; Medicine, Universidad Católica San Antonio, Murcia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Abellán-Aleman
authors.affiliation: Hypertension Unit, Hospital Doce de Octubre, Madrid, Spain; Instituto de investigación Hospital doce de Octubre, Madrid, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Segura
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, IdiPAZ, CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de investigación Hospital doce de Octubre, Madrid, Spain.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007022:Hypotension / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D015995:Prevalence; D012737:Sex Factors; D059466:White Coat Hypertension / Q000175:diagnosis
chemical_list: D000959:Antihypertensive Agents
keywords: Clinic blood pressure; daytime blood pressure monitoring; epidemiology; low blood pressure