OP.1A.09] ORTHOSTATIC HYPERTENSION PREDICTS MASKED HYPERTENSION IN THE VERY ELDERLY TREATED HYPERTENSIVES

Abstract

Objective: Masked hypertension (MHT) and isolated nocturnal hypertension are associated with increased risk of target organ damage and cardiovascular events. We investigated prevalence and predictors of those blood pressure phenotypes in very elderly treated hypertensives. Design and method: Office blood pressure evaluation (simultaneous bilateral brachial blood pressure measurements in supine position and then after 2 minutes of standing) and 24-h ambulatory blood pressure monitoring (ABPM) were performed with a validated oscillometric cuff-based device iin 67 treated hypertensive subjects older than 80 years (mean age 84.1 ± 3.1 years, 25.5% male, mean office brachial SBP 134.8 ± 23.2 mm Hg). Patients with left ventricular ejection fraction < 40% and severe comorbidities were not included. Orthostatic hypotension (OH) was defined as a decrease in SBP of at least 20 mm Hg upon standing and orthostatic hypertension (OHT) as a corresponding increase. Results: The prevalence of MHT was 47.7% in the entire study population and 71.1% among patients with office-controlled hypertension (BP < 150/90 mm Hg). 78.2% patients with MHT had isolated nocturnal hypertension. Orthostatic reaction was abnormal in 34.3% subjects: 22.4% participants had OH while incidence of OHT was 11.9%. OHT was significantly associated with MHT (RR = 1.7, 95% CI = 1.14–2.78). Conclusions: OHT is predictive for MHT in the very elderly treated hypertensives. Evaluation of orthostatic reaction in very elderly may help to detect a population that would benefit from ABPM.