Abstract P008: Pulse Pressure Following a Brief Patient Rest Period: Age and Gender Variations

Abstract

Background: Increased pulse pressure (PP) is an independent determinant of cardiovascular disease. The effect of rest period on office-based systolic blood pressure has been previously reported, but not on PP in particular. Whether such rest period impacts the measured pulse pressure, and the variability of such response with age and gender remains unknown. Methods: Patient charts reviewed in University-based cardiology clinic identified 170 encounters which contained blood pressure (BP) re-measurement data due to elevated initial BP of > 130/80 mmHg. BP was measured initially by the nurse, with the patient in a sitting position and the arm resting at the level of the heart. If BP was > 130/80 mmHg, it was repeated by the physician after resting the patient for 15 minutes. There were 112 (66%) elderly patients ≥ 60 years of age and 58 (34%) younger patients < 60 years of age. Among the elderly patients, there were 51 males (46%) and 61 females (54%). Results: Among all encounters, after a brief rest period, initial pulse pressure (PP) of 67 ± 2 mmHg decreased to 62 ± 1 mmHg (5 mmHg; P < 0.01). PP decreased by 8 mmHg in the elderly (72 ± 2 to 64 ± 2 mmHg; P < 0.01) but did not significantly change in the young (56 ± 3 to 58 ± 3 mmHg; P = NS). PP decrease among the elderly was more pronounced in females (11 mmHg; 76 ± 4 to 65 ± 2 mmHg; P < 0.01) compared with males (4 mmHg; 68 ± 3 to 64 ± 2 mmHg; P = 0.03). Conclusion: Hypertension is a challenging public health problem. The new ACC/AHA High Blood Pressure Guidelines have decreased the range for Stage 1 hypertension to systolic blood pressure of 130-139 mmHg, and diastolic blood pressure of 80-89 mmHg, with normal blood pressure as less than 120/80 mmHg. Blood pressure guidelines recommend that prior to BP measurement, persons should be seated quietly for at least 5 minutes in a chair, with feet on the floor, and arm supported at heart level; which resulted in significant decrease in pulse pressure in our patients. We show that while a decrease in pulse pressure was confined to the elderly, elderly females had a more pronounced PP decrease compared to males; both, however, fell to the same level. White coat hypertension may explain this observation, since it is more frequent in elderly females. The implication of this observation is that physicians should take extra care in re-measuring the blood pressure and pulse pressure, especially in elderly females, in whom a more pronounced drop in pressure may be observed after a brief rest period, and thereby, result in reclassifying their risk and need for treatment.