Key result
In elderly adults, ambulatory blood pressure variables such as nocturnal pulse pressure (OR 1.03) were better associated with carotid atherosclerotic plaques than clinic blood pressure (P<0.05).
Why the study?
Does ambulatory blood pressure monitoring correlate better with vascular damage than clinic blood pressure in the elderly?
Cross-Sectional (n=292)
Does ambulatory blood pressure monitoring correlate better with vascular damage than clinic blood pressure in the elderly?
In elderly patients, ambulatory blood pressure monitoring, particularly systolic variables like pulse pressure and blood pressure load, correlates better with carotid vascular damage than clinic blood pressure.
Ambulatory BP variables may better reflect carotid plaque risk than clinic readings in elderly adults; hypothesis-generating, requires longitudinal validation before practice change.
OBJECTIVES: In middle-aged adults, vascular damage correlates better with ambulatory than with clinic blood pressure. This study aimed to determine whether vascular damage evaluated by carotid ultrasonography in the elderly is also more closely related to ambulatory than to clinic blood pressure, and which blood pressure variables are better associated with vascular damage. METHODS: Cross-sectional study of 292 randomly selected >65 years old participants who underwent 24-h noninvasive ambulatory blood pressure monitoring. Blood pressure variables analyzed were (a) clinic blood pressure: systolic and diastolic blood pressure, pulse pressure; (b) ambulatory blood pressure monitoring: mean values of systolic and diastolic blood pressure, systolic and diastolic blood pressure load, pulse pressure, as well as variability, evaluated within 24 h, diurnal and nocturnal periods; and day-night blood pressure difference. A clinical history, physical examination, carotid ultrasonography and laboratory tests were performed. To estimate the relationship between blood pressure and vascular damage, univariate and multivariate analyses were performed. RESULTS: Mean age: 73+/-6 years, 45% men, 76.7% hypertensive patients. In the simple regression analysis, the best significant correlations (P<0.05) were common carotid intima-media thickness with 24-h and nocturnal pulse pressure (r=0.32), and common carotid diameter with 24-h systolic blood pressure load (r=0.47). In the multivariate analysis, the significant associations (P<0.05) were (a) linear regression: nocturnal pulse pressure with common carotid intima-media thickness, and diurnal pulse pressure as well as 24-h systolic blood pressure load with common carotid diameter; (b) logistic regression, adjusted odds ratio: nocturnal pulse pressure and nocturnal diastolic blood pressure load with the presence of carotid atherosclerotic plaques 1.03 and 0.98, respectively. CONCLUSIONS: In the elderly, ambulatory blood pressure monitoring is better associated with carotid damage than clinic blood pressure. Systolic blood pressure variables are the best associated, blood pressure load and pulse pressure being better associated with carotid damage than the mean levels of ambulatory blood pressure.
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Blanco et al. (2006) conducted a cross-sectional in Hypertension and vascular damage (n=292). Ambulatory blood pressure vs. Clinic blood pressure was evaluated on Presence of carotid atherosclerotic plaques (OR 1.03, p=<0.05). In elderly adults, ambulatory blood pressure variables such as nocturnal pulse pressure (OR 1.03) were better associated with carotid atherosclerotic plaques than clinic blood pressure (P<0.05).
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