The Key Role of Ambulatory Blood Pressure Monitoring in the Detection of Masked Hypertension and Other Phenomena in Frail Geriatric Patients

Background and Objectives: This study aims to determine prevalence of masked uncontrolled hypertension (MUH) in frail geriatric patients with arterial hypertension and thus show the role of ambulatory blood pressure monitoring (ABPM) since hypertension occurs in more than 80% of people 60+ years and cardiovascular diseases are the main cause of death worldwide. Despite modern pharmacotherapy, use of combination therapy and normal office blood pressure (BP), patients’ prognoses might worsen due to inadequate therapy (never-detected MUH). Materials and Methods: 118 frail geriatric patients (84.2 ± 4.4 years) treated for arterial hypertension with office BP < 140/90 mmHg participated in the study. 24-h ABPM and clinical examination were performed. Results: Although patients were normotensive in the office, 24-h measurements showed that BP values in 72% of hypertensives were not in the target range: MUH was identified in 47 (40%) patients during 24 h, in 48 (41%) patients during daytime and nocturnal hypertension in 60 (51%) patients. Conclusions: ABPM is essential for frail geriatric patients due to high prevalence of MUH, which cannot be detected based on office BP measurements. ABPM also helps to detect exaggerated morning surge, isolated systolic hypertension, dipping/non-dipping, and set and properly manage adequate treatment, which reduces incidence of cardiovascular events and contributes to decreasing the financial burden of society.

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Management of patients with uncontrolled arterial hypertension - the role of electronic compliance monitoring, 24 hour ambulatory blood pressure monitoring and candesartan/hydrochlorothiazide (HCTZ)

http://isrctn.org/> ◽

10.1186/isrctn02311110 ◽

2013 ◽

Author(s):

Thomas Mengden

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Compliance Monitoring ◽

Pressure Monitoring

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Abstract 166: The Role of Ambulatory Blood Pressure Monitoring in Pediatric Hypertension Confirmation: A Cost and Efficacy analysis

Hypertension ◽

10.1161/hyp.62.suppl_1.a166 ◽

2013 ◽

Vol 62 (suppl_1) ◽

Author(s):

Marguerite L Davis ◽

Michael A Ferguson ◽

Justin P Zachariah

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Average Cost ◽

Blood Pressure Monitoring ◽

Confirmatory Test ◽

Masked Hypertension ◽

Pressure Monitoring ◽

Work Up

Background: With the goal of averting future cardiovascular disease, the Affordable Care Act of 2010 mandates population-wide identification of children with high blood pressure (BP). Since children are prone to white coat (reactive) hypertension and masked hypertension, ambulatory blood pressure monitoring (ABPM) may be a cost-effective confirmatory test and therefore of high relevance to this mandate. Using actual patient data we evaluated the role of ABPM in patients referred to specialty clinic for evaluation of elevated blood pressure. Methods: From an unselected group of consecutive referral patients all receiving ABPM (n=58), we collected ABPM results, clinic auscultative BP and subsequent work-up patterns. Pre-elevated (90-95% referenced to age-sex-height) and elevated (>95%) clinic BP (CBP) were defined per NHLBI 2011 integrated guidelines. ABPM stratified patients into a) normal (mean 24 systolic BP (SBP) < 95%; SBP load <25%);b) pre-elevated (mean 24 SBP 25%); and c)elevated (mean 24 hour SBP >95%; SBP load >25%). ABPM was treated as the gold standard. We then compared 3 high BP confirmation strategies: 1. Average CBP alone to stratify into normal, pre-elevated, or elevated BP; 2. CBP followed by ABPM for CBP > 90%ile, using CBP and ABPM to stratify; 3. ABPM alone to stratify. The scenarios were compared by a) proportion elevated BP children appropriately identified; b) charges incurred. Charges included NHLBI 2011 recommended evaluation for elevated BP, extended secondary etiology work-up when indicated, target organ damage assessment in all pre-elevated, and screening for co-morbidities in obese pre-elevated patients. Rates of secondary etiology work-up and proportion obese were derived from the clinical cohort. We used an average cost approach with charges gleaned from our institution rate book. Results: CBP alone, CBP + ABPM, and ABPM alone identified 33.3% (3/9), 44.4% (4/9), and 100% (9/9) hypertensive cases respectively. Cost per hypertensive patient identified in each scenario was $28,994; $14,312; and $11,336 respectively. Conclusion: Given pediatric high BP is uncommon with many false positives and negatives, ABPM as a universal confirmatory test identifies more true hypertensives at a lower average cost.

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