Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals?

Q: What are the key findings of this study?

CHA2DS2VASc score was independently associated with night-time mean ambulatory diastolic blood pressure < 65 mmHg in fit elderly hypertensive patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=174). Intervention: Comorbidity burden (CHA2DS2VASc score and Charlson Comorbidity Index) vs. Lower comorbidity burden (CHA2DS2VASc score = 1, CCI = 0). Primary outcome: Night-time mean ambulatory diastolic blood pressure < 65 mmHg (OR 1.518, 95% CI 1.161-1.985, p=0.002).

Q: What does this research mean for the field?

Higher comorbidity burden measured by CHA2DS2-VASc score is independently associated with night-time ambulatory diastolic hypotension in elderly fit hypertensive individuals. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the relationship between ambulatory blood pressure monitoring measures and comorbidity burden in fit elderly individuals attending an outpatient hypertension clinic.

Alfredo De Giorgi; Rosaria Cappadona; Caterina Savriè; Benedetta Boari; Ruana Tiseo; Giulia Marta Viglione; Christian Molino; Elisa Misurati; Mauro Pasin; Roberto Manfredini; Fabio Fabbian

doi:10.11909/j.issn.1671-5411.2022.04.009

April 28, 2022Open Access

Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals?

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Key result

Higher CHA2DS2VASc score linked to ~52% higher odds of nocturnal diastolic hypotension in elderly hypertensives.

OR 1.518
95% CI 1.161-1.985
P=0.002
n=174

Why the study?

Masked diastolic hypotension is a new blood pressure pattern detected by ABPM in elderly hypertensives, but its relation to comorbidity in fit elderly subjects remains to be evaluated.

Is a higher comorbidity burden (assessed by CCI and CHA2DS2VASc score) associated with night-time ambulatory diastolic hypotension (<65 mmHg) in elderly fit hypertensive patients?

Key Points

To evaluate the relationship between ambulatory blood pressure monitoring measures and comorbidity burden in fit elderly individuals attending an outpatient hypertension clinic.
Retrospective cohort analysis of 174 hypertensive patients aged ≥ 65 years (mean age 72.1 ± 5.2 years; 93 men [53.4%]) evaluated with 24-hour ambulatory blood pressure monitoring (ABPM).
Comorbidity was quantified using the Charlson comorbidity index (CCI) and CHA2DS2VASc score, defining diastolic hypotension as mean ambulatory diastolic blood pressure < 65 mmHg.
Night-time mean diastolic values < 65 mmHg occurred in 86 subjects (49.4%) and were significantly more frequent in females than males (54.7% vs. 45.3%, P = 0.048; OR = 1.914, 95% CI: 1.047−3.500).
Multivariate logistic regression showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic blood pressure < 65 mmHg (OR = 1.518, 95% CI: 1.161−1.985; P = 0.002), whereas CCI was not.
Ambulatory diastolic hypotension (< 65 mmHg) was present in 30 subjects (17.2%) across the 24-hour monitoring period and in 22 subjects (12.6%) during daytime hours.

Study Design

Type

Cohort (n=174)

Multicenter

No

Structured PICO

Is a higher comorbidity burden (assessed by CCI and CHA2DS2VASc score) associated with night-time ambulatory diastolic hypotension (<65 mmHg) in elderly fit hypertensive patients?

P

Population

174 elderly fit hypertensive patients (mean age 72.1 years, 46.6% female) in Italy undergoing 24-hour ambulatory blood pressure monitoring.

E

Exposure

Comorbidity burden assessed by Charlson Comorbidity Index (CCI) and CHA2DS2VASc score during 24-hour ambulatory blood pressure monitoring (ABPM) on continued antihypertensive therapy.

C

Comparator

Stratification by lower comorbidity burden (CCI = 0 vs CCI = 1 vs CCI ≥ 2; CHA2DS2VASc score = 1 vs CHA2DS2VASc score ≥ 2).

O

Outcome

Night-time mean ambulatory diastolic blood pressure < 65 mmHg (masked diastolic hypotension) during 24-hour ABPM (night-time defined as 23:00–06:00).surrogate

Main Result

Odds Ratio: 1.518 (95% CI 1.161–1.985)

p-value: p=0.002

In elderly fit hypertensive patients, higher comorbidity burden as measured by the CHA2DS2VASc score and female sex are associated with nocturnal ambulatory diastolic hypotension (<65 mmHg), highlighting the utility of ABPM to prevent antihypertensive overtreatment.

Limitations

Retrospective design analyzing a selected sample of subjects
Single-center data limiting generalizability
Charlson Comorbidity Index may not correctly quantify disease burden in elderly patients compared to scales like the Cumulative Illness Rating Scale
Fixed night-time period definition (23:00 to 06:00) rather than an actigraphy-based approach, with modest reproducibility of nocturnal BP patterns
Evaluated only patients under antihypertensive treatment without assessing the timing of drug administration
Single-center data collection limiting generalizability
Use of Charlson Comorbidity Index, which does not quantify disease burden in elderly patients as accurately as the Cumulative Illness Rating Scale
Fixed night-time period definition (23:00 to 06:00) rather than actigraphy-based approach
Evaluated only treated hypertensive patients without evaluating timing of antihypertensive drug administration

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Implication

May warrant ABPM caution against overtreatment in comorbid elderly hypertensives; leaves open causal impact on outcomes.

Abstract

BACKGROUND Masked diastolic hypotension is a new blood pressure (BP) pattern detected by ambulatory blood pressure monitoring (ABPM) in elderly hypertensives. The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic. METHODS Comorbidity was assessed by Charlson comorbidity index (CCI) and CHA2DS2VASc score. All subjects evaluated with ABPM were aged ≥ 65 years. CCI and CHA2DS2VASc score were calculated. Diastolic hypotension was defined as mean ambulatory diastolic BP < 65 mmHg and logistic regression analysis was carried out in order to detect and independent relationship between comorbidity burden and night-time diastolic BP < 65 mmHg. RESULTS We studied 174 hypertensive elderly patients aged 72.1 ± 5.2 years, men were 93 (53.4%). Mean CCI was 0.91 ± 1.14 and mean CHA2DS2VASc score of 2.68 ± 1.22. Subjects with night-time mean diastolic values < 65 mmHg were higher in females [54.7% vs. 45.3%, P = 0.048; odds ratio (OR) = 1.914, 95% CI: 1.047−3.500]. Logistic regression analysis showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic values < 65 mmHg (OR = 1.518, 95% CI: 1.161−1.985; P = 0.002), but CCI was not. CONCLUSIONS ABPM and comorbidity evaluation appear associated in elderly fit subjects with masked hypotension. Comorbid women appear to have higher risk for low ambulatory BP.

Discussion

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Cite This Study

Giorgi et al. (2022) conducted a cohort in Hypertension (n=174). Comorbidity burden (CHA2DS2VASc score and Charlson Comorbidity Index) vs. Lower comorbidity burden (CHA2DS2VASc score = 1, CCI = 0) was evaluated on Night-time mean ambulatory diastolic blood pressure < 65 mmHg (OR 1.518, 95% CI 1.161-1.985, p=0.002). CHA2DS2VASc score was independently associated with night-time mean ambulatory diastolic blood pressure < 65 mmHg in fit elderly hypertensive patients.

synapsesocial.com/papers/6a70abb0e36a167817e27e63 https://doi.org/10.11909/j.issn.1671-5411.2022.04.009

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Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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