WHITE COAT HYPERTENSION IS HIGHLY PREVALENT IN FRAIL ELDERLY ADMITTED IN NURSING HOME. RESULTS OF A STUDY CONDUCTED WITH AMBULATORY BLOOD PRESSURE MONITORING: PP.14.12

Abstract

The elderly population living in nursing home is quite peculiar because of its high prevalence of comorbidity, disability and incidence of cognitive impairment. At present there are no data on the specific effects of hypertension in this population. Aim of the study was to verify the prevalence of hypertension in patients living in nursing homes and to evaluate the relation between clinical blood pressure and ambulatory blood pressure monitoring in this population (ABPM). Methods: study population was composed by 273 patients (mean age 81 years) divided in three groups: Group A: composed by hypertensive outpatients (N = 100); Group B: frail elderly admitted in nursing home (N = 100) Group C: patients admitted to the rehabilitation ward of the same centre (N = 73). Clinical and pharmacological data were collected for all patients as well as clinical blood pressure (OBP) and 24 hour ABPM (Spacelabs 90207). Definitions: ¡°White coat hypertension¡ ±: OBP≥140/90 and ABPM <135/85 mmHg; ¡°masked hypertension¡ ±: OBP<140/90 mmHg and ABPM≥135/85 mmHg). Results: Patients of group A had the higher prevalence of clinical hypertension (Group A 71%, Group B 51%; Group C 70%). We found a good correlation between blood pressure values measured clinically an with ABPM only in Group A (PAS: r = 0,54; p = < 0,001; PAD r = 0,70, p = <0,001), while the correlation was poor in Group B (PAS: r = 0,3 and p = 0,02; PAD: r = 0,11 and p = 0,2). In Group C the correlation was intermediate (PAS: r = 0,62; p = <0,001; PAD 0,44; r < 0,001). The prevalence of white coat hypertension was 14% in Group A, 57% in Group C and of 70% in Group B. Circadian rhythm analysis was preserved only in 22% both in Groups B and C. In Group A we found a higher percentage of patients with preserved circadian rhythm (33%). Conclusions: This study demonstrated a poor correlation between clinical and ambulatory blood pressure, with an high prevalence of white coat hypertension. The hypertensive patient in nursing home is very peculiar and deserves a careful management for what concerns diagnosis and treatment.