Impact of Ambulatory Blood Pressure Monitoring on Reclassification of Hypertension Prevalence and Control in Older People in Spain

Abstract

Ambulatory blood pressure monitoring (ABPM) accurately classifies blood pressure (BP) status but its impact on the prevalence and control of hypertension is little known. The authors conducted a cross-sectional study in 2012 among 1047 individuals 60 years and older from the follow-up of a population cohort in Spain. Three casual BP measurements and 24-hour ABPM were performed under standardized conditions. Approximately 68.8% patients were hypertensive based on casual BP (≥140/90 mm Hg or current BP medication use) and 62.1% based on 24-hour ABPM (≥130/ 80 mm Hg or current BP medication use) (P=.009). The proportion of patients with treatment-eligible hypertension who met BP goals increased from 37.4% based on the casual BP target to 54.1% based on the 24-hour BP target (absolute difference, 16.7%; P<.01). These results were consistent across alternative BP thresholds. Therefore, compared with casual BP, 24-hour ABPM led to a reduction in the proportion of older patients recommended for hypertension treatment and a substantial increase in the proportion of those with hypertension control. J Clin Hypertens (Greenwich). 2015;17:453-461. ª 2015 Wiley Periodicals, Inc.High blood pressure (BP) poses a serious cardiovascular risk to the individual and a burden to the population.

Social support and ambulatory blood pressure in older people

“…Ninety-five participants died during follow-up; from the remaining 2519 subjects, 2037 provided updated information for the phone interview, the physical examination, diet and medication. Baseline sociodemographic and clinical characteristics of the participants at the inception of the cohort were reasonably similar to those who did not participate [28].…”

“…Data were taken from the Seniors-ENRICA cohort, whose methods have been previously reported [27,28]. In brief, this cohort was established between 2008 and 2010 with 2614 non-institutionalized individuals selected through stratified random sampling from the population aged 60 years and older in Spain.…”

“…Compared with participants without ABPM, those who underwent the measurement had similar age (71.8 years vs 71.7 years), proportion of men (47% vs 49%), education level (63% vs 61% with ≤ primary studies), mean body mass index (BMI; 27.8 kg/m 2 vs 27.5 kg/m 2 ), proportion of diabetes (15.1% vs 16.1%), current smoking (11.0% vs 11.7%), and history of cardiovascular disease (5.7% vs 4.5%) [28].…”

Ambulatory Blood Pressure Monitoring for the Effective Management of Antihypertensive Drug Treatment

“…The daunting reality is that only half of all Spanish individuals were within the normal range for both casual BP and ABPM and less than half of individuals with elevated casual BP and ABPM were receiving antihypertensive medication. 12 The concluding messages from the Spanish study are that, compared with casual BP measurement, ABPM led to a reduction in the proportion of older individuals recommended for hypertension treatment and a substantial increase in the proportion of those whose hypertension was controlled. ABPM would reduce misdiagnosis, ensure that the right people are treated with BP-lowering drugs, and reduce the number of patients treated for hypertension.…”

“…One analysis of the Spanish database again supports the use of ABPM as a means of gaining greater insight into the subtleties of drug effects on BP. 12 The study found that 700,000 elderly individuals would have been spared medication if ABPM, instead of casual BP, had been performed. On the other hand, the percentage of patients considered eligible for treatment increased by 6% with ABPM, which amounted to 350,000 elderly patients.…”