The value of ambulatory blood pressure measurement to detect masked diastolic hypotension in older patients treated for hypertension

Abstract Objective assess how many patients with low ambulatory diastolic blood pressure (DBP) are not identified when relying on office DBP alone, and thus have ‘masked diastolic hypotension’. Design cross-sectional, retrospective cohort study. Setting academic hospital. Subjects 848 patients treat...

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Bibliographic Details
Published in:	Age and ageing Vol. 50; no. 4; pp. 1229 - 1235
Main Authors:	Kleipool, Emma E F, Rozendaal, Eva S, Mahadew, Shaya K N, Kramer, Mark H H, van den Born, Bert-Jan H, Serné, Erik H, Peters, Mike J L, Muller, Majon
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01-07-2021 Oxford Publishing Limited (England)
Subjects:	Antihypertensives Blood pressure Cardiology Cardiovascular disease Cardiovascular diseases Cohort analysis Coronary artery Coronary artery disease Diabetes Diabetes mellitus Discontinued Heart diseases Hypertension Hypotension Measurement Patients Side effects hypotension blood pressure ageing, older people diastolic blood pressure
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Summary:	Abstract Objective assess how many patients with low ambulatory diastolic blood pressure (DBP) are not identified when relying on office DBP alone, and thus have ‘masked diastolic hypotension’. Design cross-sectional, retrospective cohort study. Setting academic hospital. Subjects 848 patients treated for hypertension who received ambulatory blood pressure monitoring (ABPM). Methods cut-off value between on- and off-target systolic blood pressure (SBP): 140 mmHg. Cut-off for low office and/or ambulatory DBP: DBP ≤ 70 mmHg. ‘Masked diastolic hypotension’ was defined as office DBP > 70 mmHg and mean ambulatory DBP ≤ 70 mmHg. Results mean age of the sample was 60 ± 13 years, 50% was female, 37% had diabetes, 42% preexisting cardiovascular disease (CVD), mean office blood pressure (BP) was 134/79 mmHg. In all patients (n = 848), low office DBP was present in n = 84(10%), while n = 183(22%) had low ambulatory DBP. In all patients with normal-to-high office DBP (n = 764), n = 122(16%) had ‘masked diastolic hypotension’. In this group, ambulatory DBP was 14–19 mmHg lower than office DBP. Patients with low ambulatory DBP were older, had more (cardiovascular) comorbidities, and used more (antihypertensive) drugs. Antihypertensive drugs were lowered or discontinued in 30% of all patients with ‘masked diastolic hypotension’ due to side effects. Conclusions ‘masked diastolic hypotension’ is common among patients treated for hypertension, particularly in older patients with CVD (e.g. coronary artery disease, diabetes), patient groups in which the European Society of Cardiology/Hypertension guideline advises to prevent low DBP. Although it remains to be examined at which BP levels the harms of low DBP outweigh the benefits of lowering SBP, our observations are aimed to increase awareness among physicians.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-0729 1468-2834
DOI:	10.1093/ageing/afaa287