Arterial hypotension in patients with essential hypertension II–III: unresolved issues and ambulatory blood pressure monitoring diagnostic criteria

Abstract

The aim was to study the prevalence of sustained arterial hypotension in high cardiovascular risk patients with II–III stage essential hypertension and associated factors. Materials and methods. Patients with II–II stage essential hypertension and sinus rhythm (n = 179, mean age 61 (95 % CI: 59.6‒62.5) years, 57.0 % were males) underwent ambulatory blood pressure monitoring (ABPM). Arterial hypotension episodes were evaluated according to the blood pressure (BP) office measurement (<110/70 mm Hg) and ABPM over 24 hours (<100/60 mm Hg), daytime (<105/65 mm Hg) and nighttime (<90/50 mm Hg). To determine the covariates associated with the probability of arterial hypotension, models were constructed using binary logistic regression analysis. Results. There was an almost threefold increase in the prevalence of arterial hypotension according to ABPM (6.2 %, 11/179), compared with the results of office measurement (2.2 %, 4/179). The prevalence of masked arterial hypotension was 63.6 %. Hypotension episodes (n = 22) were detected in 11 patients mainly during the daytime (13/22). Hypotension was represented by a significant percentage of people with isolated diastolic (81.8 %) and lower – with systo-diastolic fall in BP (18.2 %). Hypotension associated risk factors were reaching the target level of intensive BP control, lower mean arterial pressure (24-hour time, daytime, nighttime analysis), its extreme dipping pattern, and female sex. Conclusions. The method of ABPM has advantages over office BP measurement in detecting episodes of sustained arterial hypotension. The risk of developing hypotension is increased in intensive BP control. The sustained hypotension is associated with lower mean arterial pressure values, its extreme dipping pattern and female sex.