Background: Blood pressure (BP) variations occurring after hospital discharge in a population of older hypertensives have not been previously investigated.
Design: elderly (≥65 years) hypertensives admitted to the geriatric acute ward of a university-teaching hospital were enrolled in this prospective observational study.
Methods: Exclusion criteria were terminal illness, discharge to institution, and changes in antihypertensive regimen. BP was recorded in the emergency room, at ward admission, daily during hospital stay, and at discharge. Home self blood pressure measurement was performed after discharge.
Results: The study population included 106 patients. There was a significant decrease in systolic BP (SBP) and diastolic BP (DBP) throughout the study time points. SBP and DBP decreased after discharge (from 135.1 ± 15.0 to 131.5 ± 16.1 mmHg and from 77.2 ± 8.4 to 71.6 ± 8.7 mmHg, respectively), the difference being significant only for DBP (p = 0.000). We further observed higher prevalence of critically low BP values (SBP <120 mmHg and DBP <70 mmHg) at home (23.6% and 48.1%, respectively) compared to discharge (8.5% and 9.4%, p = 0.006 and p = 0.000, respectively).
Conclusions: We observed a decrease in BP values, and particularly DBP values, after hospital discharge, in a sample of older hypertensives. Critically low BP values were observed at home in a high proportion of subjects, suggesting wise use of antihypertensive therapy at discharge and early monitoring of BP values at home.
AndersenUOJensenGB. Trends and determinant factors for population blood pressure with 25 years of follow-up: results from the Copenhagen City Heart Study. Eur J Cardiovasc Prev Rehabil2010; 17(6): 655–659.
2.
ManciaGDe BakerGDominiczakACifkovaRFagardRGermanoG. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens2007; 25(9): 1751–1762.
3.
ZanchettiAGrassiGManciaG. When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens2009; 27(5): 923–934.
4.
ManciaGLaurentSAgabiti-RoseiEAmbrosiniEBurnierMCaulfieldMJ. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press2009; 18(6): 308–347.
5.
SatishSFreemanDHRayLGoodwinJS. The relationship between blood pressure and mortality in the oldest old. J Am Geriatr Soc2001; 49(4): 367–374.
6.
LangerRDCriquiMHBarrett-ConnorELKlauberMRGaniatsTG. Blood pressure change and survival after age 75. Hypertension1993; 22(4): 551–559.
7.
Van BemmelTGusseklooJWestendorpRGJBlauwGJ. In a population-based prospective study, no association between high blood pressure and mortality after age 85 years. J Hypertens2006; 24(2): 287–292.
8.
RastasSPirttilaTViramoPVerkkoniemiAHalonenPJuvaK. Association between blood pressure and survival over 9 years in a general population aged 85 and older. J Am Geriatr Soc2006; 54(6): 912–918.
9.
MolanderLLovheimHNormanTNordstromPGustafsonY. Lower systolic blood pressure is associated with greater mortality in people aged 85 and older. J Am Geriatr Soc2008; 56(10): 1853–1859.
10.
SteassenJA. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet2000; 355(9207): 865–872.
11.
UngarAPepeGLambertucciLFedeliAMonamiMMannucciE. Low diastolic ambulatory blood pressure is associated with greater all cause mortality in older patients with hypertension. J Am Geriatr Soc2009; 57(2): 291–296.
12.
LangerRDGaniatsTGBarrett-ConnorE. Factors associated with paradoxical survival at higher blood pressures in the very old. Am J Epidemiol1991; 134(1): 29–38.
13.
BoMMassaiaMMerloCSonaACanadèAFonteG. White-coat effect among older patients with suspected cognitive impairment: prevalence and clinical implications. Int J Geriatr Psychiatry2009; 24(5): 509–517.
14.
GuptaVLipsitzLA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med2007; 120(10): 841–847.
KatzSFordABMoskowitzRWJaksonBAJaffeMW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA1963; 185: 914–919.
17.
LawtonMPBrodyEM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist1969; 9(3): 179–186.
18.
PfeifferE. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc1975; 23(10): 433–441.
19.
YesavageJABrinkTLRoseTLLumOHuangVAdeyM. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res1982; 17(1): 37–49.
20.
SpitzerRLKroenkeKWillliamsJBLoweB. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med2006; 166(10): 1092–1097.
21.
O'BrienEWaeberBParatiGStaessenJMyersMG. Blood pressure measuring devices: recommendations of the European Society of Hypertension. Br Med J2001; 322(7285): 531–536.
22.
VerberkWJKroonAAKesselsAGLendersJWThienTvan MontfransGA. The optimal scheme of self blood pressure measurement as determined from ambulatory blood pressure recordings. J Hypertens2006; 24(8): 1541–1548.
23.
ZyczkowskaJKlich-RaczkaAWiznerBMossakowskaMWieczorowska-TobisKGrodzickiT. The prevalence of cardiovascular risk factors among centenarians is low: risk factors in centenarians. Eur J Cardiovasc Prev Rehabil2006; 13(6): 993–995.
