Ambulatory Blood Pressure Measurement as a Predictor of Hypertension Mediated Target Organ Damage in Very Elderly Population: The Mapachess Study

Abstract

Objective:International guidelines recommend Ambulatory Blood Pressure Monitoring (ABPM) in the diagnosis and follow-up of hypertensive patients based on the superior reliability prognostic value compared to office BP. Our objective was to analyze the relationship between ABPM control and target organ damage (TOD) in the elderly population.Design and method:Observational, retrospective, longitudinal study of a cohort of treated hypertensive patients older than 75 years. A baseline ABPM was obtained in all patients and was repeated after 6 months follow-up. Clinical data on associated CVRF, TOD, cardiovascular events, and emergency room visits were collected at baseline and 6 months of follow-up.Results:A total of 39 consecutive patients were included, 38.5% women, mean age 80 years (75–89), 30% diabetic, 50% obese and 58% dyslipidemic. Previous stroke was observed in 5.6% patients and 9% had a previous acute myocardial infarction (AMI). The mean in-treatment office BP was 142 (± 22) / 71 (± 14) mm Hg and 30.8% were controlled (BP < 140/90 mmHg). The mean in-treatment 24-hour BP was 141 (± 15) / 70 (± 11) mm Hg. New CV events were observed in 19.7 during follow-up. When we compared the characteristics between the group with good ABPM (defined as mean 24 h BP < 130/80 mm Hg) and the group with poor control, only left ventricular mass index (LVMI) was significantly higher in the latter (170 g/m2 (poor control) vs. 128 g/m2 (good control); Anova p 0.044).Conclusions:In treated elderly hypertensive patients, poor BP control by 24h-ABPM is significantly correlated with a greater degree of LVH. Considering the retrospective design of this pilot study in a very limited number of patients, these findings need to be confirmed in larger studies.