HIDDEN CENTRAL HYPERTENSION AND SPURIOUS HYPERTENSION IN ELDERLY PEOPLE

Abstract

Objective: Determination of brachial systolic blood pressure (SBP-b) and central systolic blood pressure (SBP-c) in the elderly could contribute to their better management by the identification of hidden central hypertension (HCH) and spurious hypertension (SH). Objectives: a) to analyse SBP-b and SBP-c relationship, b) to determine prevalence and phenotypes of HCH and SH, c) to evaluate antihypertensive treatment; d) to identify risk of orthostatic hypotension (OH). Methods: We included patients older than 65 years old who consecutively consulted to the participating sites (2014–2019) retrospectively and accordingly to their previous hypertension diagnosis were classified as hypertensives or normotensives. Brachial and central blood pressure measurements allow us to identify four phenotypes: 1) normal SBP-b with high SBP-c, 2) high SBP-b with normal SBP-c, 3) both normal, 4) both high. Statistical: Student test, ANOVA, Chi2. Design and method: 1595 subjects were recruited (female 47.8%, 70.9 ± 5.2 years); 66.6%(n:1063) hypertensive/33.3%(n:532) normotensives. We identified HCH in 7.9%(n:84), SH in 5.2%(n:55) in hypertensive group, compared with 10.7%(n:57) and 3.4%(n:18) respectively in normotensives. Elevated values of SBP-b were detected in 27.1% normotensives, although 10.7% had normal SBP-c. Table 1 shows the baseline and hemodynamic characteristics of general population according to phenotypes. No differences were found between different classes of antihypertensive drugs, but a higher number of medications was reported in SH. OH was identified in 35%, showing 48% of them SH. Conclusion: Hidden central hypertension was present in almost 5% of elderly people while spurious hypertension in 9%, similar in hypertensives and normotensives. Phenotypically HCH subjects were older, less active, with increase PWV and AIX, but with lower HR than those with SH, who showed higher CI, HR and SVR. As it was expected, our study results suggest that elderly people with HCH could be at risk of being sub-treated and inversely, those with SH could be over-treated. The OH prevalence in SH supports this latter issue. Finally, the measurement of SBP-c seems to be a useful clinical variable that could lead to a better management of blood pressure in the elderly.