Automated blood pressure measurement (ABPM) in the elderly

Abstract

Application and feasibility of automated ambulatory blood pressure measurement (ABPM) in the elderly are comparable to younger age groups. Major side-effects are sleep disturbances and pain during cuff-inflation. The main indications for ABPM are diagnosis and control of treatment in hypertensive patients. Further indications are the diagnosis of syncope or hypotensive disorders and the diagnostic work-up of symptoms like vertigo, dizziness and dyspnea. In hypertensives, ABPM can easily assess the "white coat" effect and cases of "white coat" hypertension (prevalence in the elderly 15-25%). The prognostic implications of "white coat" hypertensions remain to be determined. Recording of the total 24-h blood pressure profile with analysis of circadian blood pressure changes, the day-night difference and the early morning surge raises the possibility to assess age-specific patterns. The drop in blood pressure at night (during sleep) is usually decreased and less frequently observed in elderly hypertensives. Possible explanations include decreased daytime activity, an altered sleep pattern in the elderly and secondary forms of hypertension. So-called "non-dippers", with no adequate drop in night-time blood pressure, show a significant increase in cardiovascular complications. Control of treatment via ABPM can assess non-responders and cases of overtreatment, and permits a fairly objective analysis of side-effects. Episodes of transient myocardial ischemia and possible trigger mechanisms can be assessed by simultaneous application of ABPM and Holter monitoring. The insufficient control of hypertension in the majority of elderly patients and the current lower target blood pressures in the elderly call for new methods to improve the level and quality of antihypertensive treatment. Although ABPM provides a closer correlation to target organ damage than measurement of office (casual) blood pressure, and ABPM frequently improves or at least facilitates the care of elderly hypertensive patients, it remains to be determined whether ABPM can finally improve the long-term outcome of these patients.