Blood pressure in the very elderly: inter-arm difference and orthostatic reaction

Aim

To evaluate inter-arm difference, orthostatic response and their clinical associations in the very elderly hypertensives.

Material and methods

Sixty seven hypertensive subjects older than 80 years (mean age 84.1±3.1 years, 25.5% male, mean clinic brachial systolic BP 134.8±23.2 mm Hg) were included in cross-sectional study. Simultaneous bilateral brachial BP measurements were performed using validated oscillometric cuff-based device in sitting postion and then after 2 minutes of standing. Central pulse waveform characteristics and arterial stiffness parameters were estimated by BPLab Vasotens system.

Results

The median of inter-arm difference in systolic BP (IADSBP) was 4.00 (2.50; 9.00) mm Hg. 25.4% participants had IADSBP ≥10 mm Hg. These patients had significantly higher body mass index (31.39±5.73 vs 28.48±4.10 kg/m2, p<0.05), waist circumference (116.3±13.6 vs 107.7±11.2 см, p<0.05) and pulse wave velocity in aorta (11.65±1.46 vs 10.75±1.71 м/с, p<0.05). Patients with asymptomatic orthostatic hypotension (22.4% of participants) had higher levels of brachial SBP and pulse pressure while central BPs and markers of arterial stiffness did not differ from those without orthostatic hypotension.

Conclusion

Significant IADSBP is associated with increased arterial stiffness and abdominal obesity in the very elderly hypertensive patients, whereas there was no evidence of interrelation between orthostatic response and arterial stiffness in such patients.

Key words

Arterial hypertension, inter-arm difference, orthostatic hypotension, very elderly.