Interest of combined blood pressure measurements in very old frail subjects: The partage study

Jean Jacques Mourad, Davide Agnoletti, Carlos Labat, Sylvie Gautier, Paolo Salvi, Filippo Valbusa, Olivier Hanon, Olivier Toulza, Patrick Manckoundia, Francesco Fantin, Yves Rolland, Athanase Benetos

Research output: Contribution to journalArticle

Abstract

BACKGROUND Several clinical studies have shown that blood pressure (BP) measurements in very old frail individuals are of limited interest due to the fact that several age-related alterations and geriatric syndromes may modify BP. We studied in persons over 80-year old living in nursing homes the combined effects of 3 BP patterns on total mortality and major cardiovascular (CV) events: (i) low pulse pressure amplification (L-PPA) between carotid and brachial artery, (ii) systolic BP (SBP) <130 mm Hg (L-SBP), under >1 antihypertensive drugs, and (iii) changes in SBP between supine and upright position of >20 mm Hg in both directions (hypotension/hypertension, orthostatic SBP [O-SBP]). METHODS This analysis was performed in subjects of the PARTAGE study presenting all these 3 measurements (n = 883). The combined effects of L-PPA, L-SBP, and O-SBP were studied during the 2 years followed-up period. RESULTS After adjusting for age, sex, and history of CV events, all 3 BP patterns were independent determinants of major CV events (L-PPA, (P = 0.023); L-SBP, (P = 0.050); O-SBP, (P = 0.015)), whereas L-PPA (P = 0.012) and L-SBP (P = 0.006) were also independent determinants of total mortality. Compared with the subjects without any BP pattern, the presence of 2 or 3 BP patterns was associated with an increase in total mortality and major CV events greater than 2 and 2.5 times, respectively. CONCLUSIONS In very old frail subjects, there is a particular interest for using different BP measurement approaches, than in younger populations, in order to evaluate the risks related to the BP levels. CLINICAL TRIALS REGISTRATION Trial Number: NCT00901355 (Clinical Trials.gov).

Original languageEnglish
Pages (from-to)950-956
Number of pages7
JournalAmerican Journal of Hypertension
Volume31
Issue number8
DOIs
Publication statusPublished - Jul 16 2018

Keywords

  • antihypertensive drugs
  • blood pressure
  • frailty
  • hypertension
  • mortality
  • orthostatic hypertension
  • orthostatic hypotension
  • pulse pressure amplification

ASJC Scopus subject areas

  • Internal Medicine

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    Mourad, J. J., Agnoletti, D., Labat, C., Gautier, S., Salvi, P., Valbusa, F., Hanon, O., Toulza, O., Manckoundia, P., Fantin, F., Rolland, Y., & Benetos, A. (2018). Interest of combined blood pressure measurements in very old frail subjects: The partage study. American Journal of Hypertension, 31(8), 950-956. https://doi.org/10.1093/ajh/hpy077