Differing Pattern of Ambulatory Blood Pressure in Very Elderly Men Expresses Dynamics in Atherosclerotic Load in the Senescence

Arkadiusz Siennicki-Lantz,Sölve Elmståhl

doi:10.1155/2012/417291

Abstract

To assess an impact of vascular risk factors on ambulatory blood pressure measurement (ABPM) in the elderly, we followed up a population-based cohort of men from 68 until 82 years, when 104 survivors underwent ABPM. Results. At age 68, hypertension and high clinic blood pressure (CBP) did not predict ABPM level. Smoking and low ankle-brachial index (ABI) predicted higher ABPM variability and pulse pressure (PP), but not absolute ABPM values. At age 82, hypertension, high or increasing CBP, strongly positively correlated with all variables of ABPM. Carotid stenosis, low or declining ABI during followup, correlated with higher nocturnal ABPM and PP. Concluding. Hypertension and vascular risk factors in a cohort of 68-year-old men do not result in higher ABPM at age 82, possibly due to inflection point in their pressure development. Higher ABPM reflects instead an increasing CBP and aggravating atherosclerosis during the preceding decade in that part of the cohort with previously favorable risk factor status.

Highlights

Blood pressure levels in the very elderly are more scattered than in younger elderly or middle-aged persons
The aim of our study was to assess a profile of ambulatory blood pressure measurement (ABPM) in a cohort of octogenarian men who were longitudinally followed since random inclusion from a population of city of Malmo, Sweden
129 subjects underwent ambulatory blood pressure monitoring (ABPM). 25 subjects were excluded according to ABPM quality criteria. 104 subjects were included into the final statistical analysis

Summary

Introduction

Blood pressure levels in the very elderly are more scattered than in younger elderly or middle-aged persons. High initial blood pressure level was typical for elderly subjects with subsequent BP decline [3]. Levels of blood pressure in the very elderly have paradoxical inverse relationship to morbidity and mortality. The most described covariates and consequences of blood pressure decline have been shorter survival [4,5,6], cognitive decline [7, 8], and dementia [9,10,11,12]. Heart studies showed that demented patients had lower blood pressure and thinner left ventricle posterior wall [13]. Cognitive impairment was common in subjects with heart failure combined with hypotension [14, 15]

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