Ambulatory blood pressure monitoring in elderly patients with chronic atrial fibrillation: is it absolutely contraindicated or a useful tool in clinical practice and research?

Abstract

The aim of this study was to test whether ambulatory blood pressure monitoring (ABPM) in elderly patients with atrial fibrillation (AF) is as feasible and reliable as ABPM is in patients with normal sinus rhythm (SR). Studies of ABPM in the elderly remain limited, and the use of this method in patients with AF remains controversial. The Italian SIIA 2008 guidelines consider ABPM 'absolutely contraindicated' for AF patients. This study was conducted on 200 hospitalized patients aged ≥ 65 years (68% females; mean age 82.4 ± 6.3 years): 100 patients with SR and 100 patients with permanent AF. Each patient completed serial blood pressure (BP) measurements with a clinical sphygmomanometer (Sphyg) and ABPM. Differences in mean heart rate (HR) between patient groups were not statistically significant. A total of 99.5% of patients were hypertensive. There were no significant differences between SR and AF patients in mean systolic BP (SBP) and diastolic BP (DBP) values, as measured with the Sphyg or by ABPM. Compared with the Sphyg, errors associated with BP measurements obtained by ABPM did not significantly differ between the two groups. ABPM proved to be as feasible as Sphyg measurements in both AF patients (intraclass correlation coefficients=0.73, 0.67 and 0.74 for SBP, DBP and HR, respectively) and SR patients (intraclass correlation coefficients=0.74, 0.58 and 0.67 for SBP, DBP and HR, respectively). A Bland-Altman plot analysis confirmed that there was good agreement between the two methods. Stable AF (HR 60-100 b.p.m.) should not be considered as an absolute contraindication for the use of ABPM, even in the elderly; it could be a 'relative' contraindication for very unstable AF patients.

Reliability of Oscillometric Blood Pressure Monitoring in Atrial Fibrillation Patients Admitted for Electric Cardioversion

“…As previously demonstrated by Pagonas and colleagues, three repeated oscillometric measurements suffice to counterbalance the greater BP variability obtained with this monitoring method without affecting the device's reliability. Indeed, the mean biases did not change significantly between before and after ECV, confirming previous findings that oscillometric devices can also be used in patients with AF . After ECV, there were no significant changes in the AF‐AF group's BP values and BP variability, as assessed with the two devices, nor were there any significant differences in the systolic and diastolic biases found before and after ECV.…”

“…Some studies have shown, however, that oscillometric measurements can be feasible in patients with AF . A recent meta‐analysis concluded that automated BP monitors already validated for use in individuals with an SR seemed to accurately measure systolic BP (SBP) but not diastolic BP (DBP) in individuals with sustained AF .…”

Application and Effects of Ambulatory Blood Pressure Monitoring in Primary Care

“…Pagonas et al 26 compared oscillometric measurement of upper arm blood pressure to invasive measurement of blood pressure under controlled settings and found intraindividual variability to be at an acceptable level. Similar reliability of ABPM readings was seen by Giantin et al 27 comparing ABPM use in patients with atrial fibrillation to those in sinus rhythm. Given the prevalence of atrial fibrillation, inclusion of these patients may actually bolster the generalizability of this study.…”

Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction

“…This may be because LVM index was used in the first‐step analysis. Fifth, patients with atrial fibrillation were included among the study patients; however, the use of ABPM in patients with atrial fibrillation has been reported and found not to affect 24‐hour BP rhythm . Finally, ORs could overestimate the association between the riser BP pattern and HFpEF.…”