Interest of Combined Blood Pressure Measurements in Very Old Frail Subjects: The PARTAGE Study. (16th July 2018)

• Record Type: Journal Article
• Authors: Mourad, Jean-Jacques; Agnoletti, Davide; Labat, Carlos; Gautier, Sylvie; Salvi, Paolo; Valbusa, Filippo; Hanon, Olivier; Toulza, Olivier; Manckoundia, Patrick; Fantin, Francesco; Rolland, Yves; Benetos, Athanase
• Is Part Of: American journal of hypertension. Volume 31:Number 8(2018:Aug.)
• Page Start: 950
• Page End: 956
• Publication Date: 2018-07-16
• Subjects: antihypertensive drugs -- blood pressure -- frailty -- pulse pressure amplification -- hypertension -- mortality -- orthostatic hypertension -- orthostatic hypotension; Hypertension -- Periodicals; 616.132005
• DOI: 10.1093/ajh/hpy077
• Languages: English
• ISSNs: 0895-7061

Abstract

Abstract: BACKGROUND: Several clinical studies have shown that blood pressure (BP) measurements in very old frail individuals are of limited interest due to the fact that several age-related alterations and geriatric syndromes may modify BP. We studied in persons over 80-year old living in nursing homes the combined effects of 3 BP patterns on total mortality and major cardiovascular (CV) events: (i) low pulse pressure amplification (L-PPA) between carotid and brachial artery, (ii) systolic BP (SBP) <130 mm Hg (L-SBP), under >1 antihypertensive drugs, and (iii) changes in SBP between supine and upright position of >20 mm Hg in both directions (hypotension/hypertension, orthostatic SBP [O-SBP]). METHODS: This analysis was performed in subjects of the PARTAGE study presenting all these 3 measurements ( n = 883). The combined effects of L-PPA, L-SBP, and O-SBP were studied during the 2 years followed-up period. RESULTS: After adjusting for age, sex, and history of CV events, all 3 BP patterns were independent determinants of major CV events (L-PPA, ( P = 0.023); L-SBP, ( P = 0.050); O-SBP, ( P = 0.015)), whereas L-PPA ( P = 0.012) and L-SBP ( P = 0.006) were also independent determinants of total mortality. Compared with the subjects without any BP pattern, the presence of 2 or 3 BP patterns was associated with an increase in total mortality and major CV events greater than 2 and 2.5 times, respectively. CONCLUSIONS: In very old frail subjects, there is a particular interest for using different BP measurement approaches, than in younger populations, in order to evaluate the risks related to the BP levels. CLINICAL TRIALS REGISTRATION: Trial Number: NCT00901355 (Clinical Trials.gov).