Ambulatory Blood Pressure Monitoring in Older Nursing Home Residents: Diagnostic and Prognostic Role

Hypertension in the Oldest Old, Beyond Guidelines

“…Moreover, in the vast group of disabled nursing home subjects, BP was found as unrelated to a 1-year mortality risk in one study [32] and inversely associated with increased 2-year mortality risk in another one [80]. Of notice, in the latter study the increased risk for mortality was restricted to subjects with SBP < 130 mmHg in combination with 2+ antihypertensive drugs, thus supporting the need of less intensive treatment in this highly impaired population.…”

“…This has been confirmed in particular among older subjects with a clinical diagnosis of isolated systolic hypertension at clinical measurement and normal BP values at ABPM, whose 10-year risk of cardiovascular morbidity and mortality was similar to subjects with persistently normal BP values, both among treated and non-treated subjects [31]. Moreover, the phenomenon is highly prevalent among older disabled subjects: in a sample of older nursing home patients undergoing ABPM, it was detected in 33 % of the whole sample and in 70 % of those with high BP at office assessment [32].…”

“…almost irrelevant in comparison with the presence of ADL disability and behavioral disorders [32], and possible beneficial effects of antihypertensive drugs have to be weighted carefully against the risk of brain hypoperfusion, falls, and fractures [7]. To screen for the presence of ADL disability, the single question regarding the ability to dress and undress oneself has been found to possess satisfactory accuracy to detect a significant impairment [62].…”

Home blood pressure measurement in elderly patients with cognitive impairment

“…Some clinical arguments other than agreement may be useful for choosing one method over another, such as orthostatic hypotension or nighttime BP dipping. However, the role of night-time BP, especially its interplay with cardiovascular events and cognitive disorders, still remains unclear in the very elderly [37,38]. Finally, as all our included patients had clinic hypertension, we could not evaluate the interest of r-HBPM for masked hypertension.…”

Blood pressure management in older people: balancing the risks

“…Based on ambulatory BP monitoring, the following thresholds for hypertension were proposed (and need to be updated in agreement with the restrictive new BP categories): 24 hours average >130/80 mm Hg, daytime (awake) average >135/85 mm Hg, asleep (night-time) average >120/70 mm Hg. Concordance between office and ambulatory BP values is imperfect in nursing home residents; yet, this disparity appears not to be important in practice since 1-year residents’ survival is rather predicted by disability than by BP 12. In long-term geriatric care, use of an automated BP device with multiple recordings on a single visit might serve as a more affordable alternative to 24 hours ambulatory BP monitoring 13…”