Blood pressure variability in elderly and senior hypertensive patients

Abstract

Background. In recent years the deterioration of the demographic situation has been noted in most countries of the world that is due to the steady increase in population of arterial hypertension and the aging of the population. According to the statistical forecast of the UN by 2025, the number of people over 60 will exceed 1 billion which is 15% of the entire global population. In Ukraine, according to epidemiological studies, the prevalence of hypertension among circulatory system diseases in adults (18 years and older) is 46.8% and almost half of patients with circulatory system diseases have elevated blood pressure. In patients aged 65 years and older, the prevalence of hypertension varies in the range of 53-72%. It has long been proven that the risk of cardiovascular and cerebrovascular complications in hypertensive patients depends not only on the absolute blood pressure level but also on fluctuations in blood pressure over different periods that is blood pressure variability. Blood pressure is not a static parameter but rather undergoes continuous fluctuations over time due to the interaction between environmental factors and behaviour on the one hand and the internal regulatory mechanisms of the cardiovascular system on the other hand. Elevated blood pressure may indicate cardiovascular dysregulation and itself may be a cardiovascular risk factor associated with increased all-cause mortality and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease and incidence of dementia. Aim. The study aimed to improve the system of prevention and diagnosis of elderly and senior hypertensive patients at the ambulatory-polyclinic stage due to the study of the contribution of blood pressure variability. Materials and methods. The group of examinees was formed taking into account 27 elderly and senile hypertensive patients including those combined with coronary artery disease. For this purpose, ambulatory blood pressure monitoring was used. Results. Systolic blood pressure variability (SD) in hypertensive patients was higher than in the control group (p<0.001). So, during the study, SD was 17.9±7.1 mm Hg. while in the control group 12.1±2.6 mm Hg. The frequency of high blood pressure variability detection in elderly and senile hypertensive patients was 51.9% (n=14). High blood pressure variability compared to low blood pressure variability and control was associated with a more pronounced systolic blood pressure variability (during the active monitoring period), and it was equalled 23.7±5.2 mm Hg compared to 14.8±6.5 mm Hg (p<0.001) and 12.1±2.6 mm Hg. (p<0.001). In elderly and senile hypertensive patients with high and low blood pressure variability, the non-dipper group prevailed over the dipper group in the structure of daily blood pressure rhythm (71.4% vs. 28.6% and 84.6% vs. 15.4% respectively). According to the ambulatory blood pressure monitoring data high blood pressure variability group compared to low blood pressure variability and controls was characterised by higher average values of the number of blood pressure indicators. In the group of high blood pressure variability patients, the average daily systolic blood pressure exceeded the control value by 10% (р<0.05). The daily index of systolic blood pressure in the group of high blood pressure variability patients was 111% higher than in patients with low blood pressure variability (p<0.05). The daily index of diastolic blood pressure in the group of high blood pressure variability patients was 140% higher than in patients with low blood pressure variability (p<0.05). The daily index of average blood pressure in the group of high blood pressure variability patients was 191% higher than in patients with low blood pressure variability (p<0.01). Conclusions. 1. High blood pressure variability has occurred in 16 out of 27 (51.9%) hypertensive elderly and senile patients. 2. The non-dipper group has predominated in the structure of blood pressure diurnal rhythm in elderly and senile hypertensive patients with high and low blood pressure variability patients. _________________________________________________________________________________________ Keywords: arterial hypertension; essential hypertension; blood pressure variability; high blood pressure variability; low blood pressure variability; elderly and senile hypertensive patients