Abstract
BackgroundSystolic blood pressure (SBP) decline has been reported in octogenarians. The aim was to study if it could be observed while measuring SBP with two methods: Korotkoff (K-BP) and Strain-Gauge-Finger-Pletysmography (SG-BP), and which of them were more reliable in expressing vascular burden.MethodsA cohort of 703 men from a population of Malmö, Sweden, were included in "Men born in 1914-study" and followed-up at ages: 68 and 81 years. 176 survivors were examined with K-BP and SG-BP at both ages, and 104 of them with Ambulatory Blood Pressure at age 81/82. Ankle Brachial Index (ABI) was measured on both occasions, and Carotid Ultrasound at age 81.ResultsFrom age 68 to 81, mean K-BP decreased in the cohort with mean 8.3 mmHg, while SG-BP increased with 13.4 mmHg. K-BP decreased in 55% and SG-BP in 31% of the subjects. At age 81, K-BP was lower than SG-BP in 72% of subjects, and correlated to high K-BP at age 68 (r = --.22; p < .05). SG-BP at age 81 was correlated with mean ambulatory 24-h SBP (r = .480; p < .0001), daytime SBP (r = .416; p < .0001), nighttime SBP (r = .395; p < .0001), and daytime and nighttime Pulse Pressure (r = .452; p < .0001 and r = .386; p < .0001). KB-BP correlated moderately only with nighttime SBP (r = .198; p = .044), and daytime and nightime pulse pressure (r = .225; p = .021 and r = .264; p = .007). Increasing SG-BP from age 68 to 81, but not K-BP, correlated with: 24-h, daytime and nighttime SBP, and mean daytime and nighttime Pulse Pressure. Increasing SG-BP was also predicted by high B-glucose and low ABI at age 68, and correlated with carotid stenosis and low ABI age 81, and the grade of ABI decrease over 13 years.ConclusionIn contrast to K-BP, values of SG-BP in octogenarians strongly correlated with Ambulatory Blood Pressure. The SG-BP decline in the last decade was rare, and increasing SG-BP better than K-BP reflected advanced atherosclerosis. It should be aware, that K-BP underdetected 46% of subjects with SG-BP equal/higher than 140 mmHg at age 81, which may lead to biased associations with risk factors due to differential misclassification by age.
Highlights
Systolic blood pressure (SBP) decline has been reported in octogenarians
Concerning the possible pitfalls during blood pressure measurement using Korotkoff technique in the elderly, we aimed to study if aging-related changes in BP could be observed in the same extent by Korotkoff as Strain gauge technique, and which of them was best correlated to Ambulatory Blood Pressure Monitoring
The baseline data in 176 study subjects of the study are presented in table 1 and include blood pressure measurments with both Korotkoff method (K-BP), Strain gauge method (SG-BP) and Ambulatory Blood Pressure
Summary
Systolic blood pressure (SBP) decline has been reported in octogenarians. The aim was to study if it could be observed while measuring SBP with two methods: Korotkoff (K-BP) and Strain-Gauge-FingerPletysmography (SG-BP), and which of them were more reliable in expressing vascular burden. BP decline was correlated with: a number of years before dementia onset [3,4], high initial BP level [5], shorter survival [6,7,8], cognitive decline [9,10] and dementia [11,12,13,14]. Different explanations for these corellates have been proposed, based on an observation that patients who died demented were characterized by a low BP and thin left ventricle posterior wall [15]. Osler’s sign is not as frequent (11% of octogenerians) [23], and the true pseudohypertension is observed in only 2/3 of the Osler-positive elderly
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