Circadian pattern in patients older than 75 years with hypertension

Abstract

Objective: To know the circadian pattern of hypertensive patients older than 75 years, by monitoring blood pressure for 24 hours.

Design and method: Multicenter cross-sectional descriptive study in hypertensive patients aged 75 or over. It was designed for a sample of 117 people, calculated for 8% hypotensive episodes, with a 95% confidence interval, 5% precision, and 25% losses.

Non-proportional stratified random sampling was performed, excluding patients with modified antihypertensive treatment in the last month and/or arrhythmias.

Through 24-hour ambulatory blood pressure monitoring, the incidence of hypotensive episodes was observed.

Associated comorbidities, antihypertensive treatment, and sleep quality during ABPM were recorded from the interview and clinical history.

Percentages, means, confidence intervals were obtained and the chi square test was performed in the bivariate analysis.

Results: Of 117 monitored patients, 100 completed the study, with a mean age of 79.2 years (SD 3.9 years) and 59% women. 91.5% of women and 58.6% of men were overweight or obese. Some type of heart disease was associated with 31% of patients, and 33% had DM2, 38% anxiety-depressive disorder, and vertigo, 16%. 50.8% of the women and 61% of the men did not have good control of the mean TAS figures in the 24-h ABPM. However, DBP was controlled in 84.7% and 80.5% of women and men, respectively. The mean BP was 145.49/78.9 (SD 21 and 11.7, respectively). 34% of the patients presented a dipper pattern. 27% have a riser pattern. 76% of the patients presented at least one episode of hypotension, which was accompanied by symptoms in 11.8% of the cases, with headache and dizziness being the most frequent. No significant association has been observed between the number of antihypertensive drugs and the occurrence of hypotensive episodes.

Conclusions: Most of the patients presented an alteration in the circadian pattern of blood pressure in ABPM and poor control of BP figures, especially at the expense of systolic blood pressure. It is advisable to monitor blood pressure in the elderly to adapt control to chronotherapy criteria.