ANALYSIS OF AMBULATORY BLOOD PRESSURE MONITORING AND BLOOD PRESSURE MANAGEMENT IN A GERIATRIC REHABILITATION UNIT

Abstract

Objective: Blood pressure variability (BPV) has proven prognostic importance. Research has shown that controlling BPV in addition to overall reduction of BP in hypertension improves cardiovascular risk. Patients with diagnosed hypertension have an increased association with wider BPVs. Ambulatory blood pressure monitoring (ABPM) is the gold standard in diagnosis of HTN and measuring BPV. We aimed to analyse ABPM data on rehabilitation inpatients and assess hypertension (HTN) management. Design and method: A retrospective analysis of ABPM data of 32 patients sequentially admitted to a geriatric rehabilitation unit in an orthopaedic hospital from Jan 2019 – Jan 2020. We measured the change in medication, quantifying it by escalation and de-escalation (addition/reduction in antihypertensives) or no change if nothing was done. In addition we measured OH. We also analysed BPV by subdividing patients into three groups – High, Medium, and Low daytime BPV based on the standard deviation of daytime SBP. Results: Patient demographics summary (Table 1). There was increased OH detected in the High variability compared to the Low group this had borderline significance (High 75% vs Low 29%, P – 0.06). 37.5% of patients on anti-HTN treatment had an average SBP > 140mmHg. 66.6% of patients with an average SBP > 140mmHg had postural hypotension. 34% of the cohort had OH. 44% of patients with an SBP > 140mmHg had no previous diagnosis of HTN. In this cohort 87% were non night-time dippers. Increased frequency of OH detected in the High variability compared to the Low. (High 75% vs Low 29%, P – 0.06). The High variability also had a significantly higher eGFR when compared to the Low variability (High 88 vs Low 60, P – 0.04) (Table 2). Conclusions: These results show that a significant sub-group of rehabilitation inpatients in our unit had inadequate blood pressure control, underdiagnosed HTN/BPV. This study has shown that ABPM is an effective method for detecting PBV, HTN and sustained night-time HTN in a geriatric rehab population. ABPM should be used as standard of care to detect BPV and OH so that labile BP can be effectively treated and falls risk reduced.