Divisón-Garrote Juan A, Ruilope Luis M, de la Sierra Alejandro, de la Cruz Juan J, Vinyoles Ernest, Gorostidi Manuel, Escobar-Cervantes Carlos, Velilla-Zancada Sonsoles M, Segura Julián, Banegas José R
Casas Ibáñez, Primary Care Center, Albacete, Spain; Medicine, Universidad Católica San Antonio, Murcia, Spain.
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.
J Am Med Dir Assoc. 2017 May 1;18(5):452.e1-452.e6. doi: 10.1016/j.jamda.2017.01.015. Epub 2017 Feb 27.
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.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study in which 5066 patients aged 80 years and older with treated hypertension drawn from the Spanish ABPM Registry were included.
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.
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.
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.
老年患者可能特别容易受到降压治疗导致血压过度降低的不良影响。因此，识别低血压尤为重要。动态血压监测（ABPM）是一种比诊室血压测量更准确的血压状态分类技术。本研究调查了接受ABPM的高龄高血压患者中低血压的患病率以及相关的人口统计学和临床因素。
设计、地点与参与者：一项横断面研究，纳入了从西班牙ABPM登记处选取的5066名年龄在80岁及以上的高血压患者。
在标准化条件下使用经过验证的设备测定诊室血压和24小时动态血压。根据先前的研究，低血压定义为诊室测量收缩压/舒张压<110和/或70 mmHg，日间ABPM<105和/或65 mmHg，夜间ABPM<90和/或50 mmHg，24小时ABPM<100和/或60 mmHg。
参与者的平均年龄为83.2±3.1岁（64.4%为女性）。总体而言，22.8%的患者有诊室低血压，33.7%有日间低血压，9.2%有夜间低血压，20.5%有24小时ABPM低血压。低血压病例的90%是由舒张压低值导致的。此外，日间ABPM检测到的低血压病例中，59.1%根据诊室血压并不属于低血压。与诊室和ABPM低血压独立相关的变量是糖尿病、冠心病以及更多种类的降压药物。
在日常临床实践中，每3名接受治疗的高龄高血压患者中就有1名根据日间ABPM可能有低血压风险。其中超过一半患有隐匿性低血压；也就是说，如果仅依靠诊室血压则无法识别。因此，ABPM对于识别动态低血压和避免过度治疗可能特别有帮助，尤其是对于患有糖尿病、心脏病或接受多种降压药物治疗的患者。
