title: Magnitude of Hypotension Based on Office and Ambulatory Blood Pressure Monitoring: Results From a Cohort of 5066 Treated Hypertensive Patients Aged 80 Years and Older.
abstract: OBJECTIVE
  Elderly patients 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. Ambulatory BP monitoring (ABPM) is a more accurate technique than office for classifying BP status. This study examined the prevalence of hypotension and associated demographic and clinical factors among very old treated hypertensive patients undergoing ABPM.
  
  
  METHODS
  Cross-sectional study in which 5066 patients aged 80 years and older with treated hypertension drawn from the Spanish ABPM Registry were included.
  
  
  METHODS
  Office BP and 24-hour ambulatory BP were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as systolic/diastolic BP <110 and/or 70 mmHg with office measurement, <105 and/or 65 mmHg with daytime ABPM, <90 and/or 50 mmHg with nighttime ABPM, and <100 and/or 60 mmHg with 24-hour ABPM.
  
  
  RESULTS
  Participants' mean age was 83.2 ± 3.1 years (64.4% women). Overall, 22.8% of patients had office hypotension, 33.7% daytime hypotension, 9.2% nighttime hypotension, and 20.5% 24-hour ABPM hypotension. Low diastolic BP values were responsible for 90% of cases of hypotension. In addition, 59.1% of the cases of hypotension detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently associated with office and ABPM hypotension were diabetes, coronary heart disease, and a higher number of antihypertensive medications.
  
  
  CONCLUSIONS
  One in 3 very elderly treated hypertensive patients attended in usual clinical practice were potentially at risk of having hypotension according to daytime ABPM. More than half of them had masked hypotension; that is, they were not identified if relying on office BP alone. Thus, ABPM could be especially helpful for identifying ambulatory hypotension and avoiding overtreatment, in particular, in patients with diabetes, heart disease, or on antihypertensive polytherapy.
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 and CIBERESP, Madrid, Spain; Instituto de investigación Hospital Doce de Octubre, School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
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: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, IdiPAZ and CIBERESP, Madrid, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: de la Cruz
authors.affiliation: La Mina Primary Care Center, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Ernest
authors.initials: E
authors.lastname: Vinyoles
authors.affiliation: Nephrology Service, Hospital Universitario Central de Asturias, RedinRed, Oviedo, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gorostidi
authors.affiliation: Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Escobar-Cervantes
authors.affiliation: Primary Care Center Espartero, Logroño, La Rioja, Spain.
authors.forename: Sonsoles M
authors.initials: SM
authors.lastname: Velilla-Zancada
authors.affiliation: Instituto de investigación Hospital Doce de Octubre, School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain; Hypertension Unit, 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 and CIBERESP, Madrid, Spain. Electronic address: joseramon.banegas@uam.es.
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
mesh_terms: D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007022:Hypotension / Q000453:epidemiology*; D008297:Male; D018670:Monitoring, Ambulatory; D015995:Prevalence; D012042:Registries; D013030:Spain
chemical_list: D000959:Antihypertensive Agents
keywords: Hypotension; ambulatory blood pressure monitoring; elderly; epidemiology; office blood pressure