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Phenomenon of declining blood pressure in elderly - high systolic levels are undervalued with Korotkoff method.

Siennicki-Lantz, Arkadiusz LU and Elmståhl, Sölve LU (2011) In BMC Geriatrics 11(57).
Abstract
BACKGROUND:

Systolic blood pressure (SBP) decline has been reported in octogenarians. The aim was to study if it could be observed while measuring SBP with two methods: Korotkoff (K-BP) and Strain-Gauge-Finger-Pletysmography (SG-BP), and which of them were more reliable in expressing vascular burden.



METHODS:

A cohort of 703 men from a population of Malmö, Sweden, were included in "Men born in 1914-study" and followed-up at ages: 68 and 81 years. 176 survivors were examined with K-BP and SG-BP at both ages, and 104 of them with Ambulatory Blood Pressure at age 81/82. Ankle Brachial Index (ABI) was measured on both occasions, and Carotid Ultrasound at age 81.



RESULTS:

From age... (More)
BACKGROUND:

Systolic blood pressure (SBP) decline has been reported in octogenarians. The aim was to study if it could be observed while measuring SBP with two methods: Korotkoff (K-BP) and Strain-Gauge-Finger-Pletysmography (SG-BP), and which of them were more reliable in expressing vascular burden.



METHODS:

A cohort of 703 men from a population of Malmö, Sweden, were included in "Men born in 1914-study" and followed-up at ages: 68 and 81 years. 176 survivors were examined with K-BP and SG-BP at both ages, and 104 of them with Ambulatory Blood Pressure at age 81/82. Ankle Brachial Index (ABI) was measured on both occasions, and Carotid Ultrasound at age 81.



RESULTS:

From age 68 to 81, mean K-BP decreased in the cohort with mean 8.3 mmHg, while SG-BP increased with 13.4 mmHg. K-BP decreased in 55% and SG-BP in 31% of the subjects. At age 81, K-BP was lower than SG-BP in 72% of subjects, and correlated to high K-BP at age 68 (r = --.22; p < .05). SG-BP at age 81 was correlated with mean ambulatory 24-h SBP (r = .480; p < .0001), daytime SBP (r = .416; p < .0001), nighttime SBP (r = .395; p < .0001), and daytime and nighttime Pulse Pressure (r = .452; p < .0001 and r = .386; p < .0001). KB-BP correlated moderately only with nighttime SBP (r = .198; p = .044), and daytime and nightime pulse pressure (r = .225; p = .021 and r = .264; p = .007). Increasing SG-BP from age 68 to 81, but not K-BP, correlated with: 24-h, daytime and nighttime SBP, and mean daytime and nighttime Pulse Pressure. Increasing SG-BP was also predicted by high B-glucose and low ABI at age 68, and correlated with carotid stenosis and low ABI age 81, and the grade of ABI decrease over 13 years.



CONCLUSION:

In contrast to K-BP, values of SG-BP in octogenarians strongly correlated with Ambulatory Blood Pressure. The SG-BP decline in the last decade was rare, and increasing SG-BP better than K-BP reflected advanced atherosclerosis. It should be aware, that K-BP underdetected 46% of subjects with SG-BP equal/higher than 140 mmHg at age 81, which may lead to biased associations with risk factors due to differential misclassification by age. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMC Geriatrics
volume
11
issue
57
publisher
BioMed Central
external identifiers
  • wos:000208731700057
  • pmid:21967408
  • scopus:80053455153
ISSN
1471-2318
DOI
10.1186/1471-2318-11-57
language
English
LU publication?
yes
id
cd42cbbb-2cfa-4020-a63f-d7083e335612 (old id 2200851)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21967408?dopt=Abstract
date added to LUP
2011-11-02 07:57:53
date last changed
2017-01-01 05:22:34
@article{cd42cbbb-2cfa-4020-a63f-d7083e335612,
  abstract     = {BACKGROUND:<br/><br>
Systolic blood pressure (SBP) decline has been reported in octogenarians. The aim was to study if it could be observed while measuring SBP with two methods: Korotkoff (K-BP) and Strain-Gauge-Finger-Pletysmography (SG-BP), and which of them were more reliable in expressing vascular burden.<br/><br>
<br/><br>
METHODS:<br/><br>
A cohort of 703 men from a population of Malmö, Sweden, were included in "Men born in 1914-study" and followed-up at ages: 68 and 81 years. 176 survivors were examined with K-BP and SG-BP at both ages, and 104 of them with Ambulatory Blood Pressure at age 81/82. Ankle Brachial Index (ABI) was measured on both occasions, and Carotid Ultrasound at age 81.<br/><br>
<br/><br>
RESULTS:<br/><br>
From age 68 to 81, mean K-BP decreased in the cohort with mean 8.3 mmHg, while SG-BP increased with 13.4 mmHg. K-BP decreased in 55% and SG-BP in 31% of the subjects. At age 81, K-BP was lower than SG-BP in 72% of subjects, and correlated to high K-BP at age 68 (r = --.22; p &lt; .05). SG-BP at age 81 was correlated with mean ambulatory 24-h SBP (r = .480; p &lt; .0001), daytime SBP (r = .416; p &lt; .0001), nighttime SBP (r = .395; p &lt; .0001), and daytime and nighttime Pulse Pressure (r = .452; p &lt; .0001 and r = .386; p &lt; .0001). KB-BP correlated moderately only with nighttime SBP (r = .198; p = .044), and daytime and nightime pulse pressure (r = .225; p = .021 and r = .264; p = .007). Increasing SG-BP from age 68 to 81, but not K-BP, correlated with: 24-h, daytime and nighttime SBP, and mean daytime and nighttime Pulse Pressure. Increasing SG-BP was also predicted by high B-glucose and low ABI at age 68, and correlated with carotid stenosis and low ABI age 81, and the grade of ABI decrease over 13 years.<br/><br>
<br/><br>
CONCLUSION:<br/><br>
In contrast to K-BP, values of SG-BP in octogenarians strongly correlated with Ambulatory Blood Pressure. The SG-BP decline in the last decade was rare, and increasing SG-BP better than K-BP reflected advanced atherosclerosis. It should be aware, that K-BP underdetected 46% of subjects with SG-BP equal/higher than 140 mmHg at age 81, which may lead to biased associations with risk factors due to differential misclassification by age.},
  author       = {Siennicki-Lantz, Arkadiusz and Elmståhl, Sölve},
  issn         = {1471-2318},
  language     = {eng},
  number       = {57},
  publisher    = {BioMed Central},
  series       = {BMC Geriatrics},
  title        = {Phenomenon of declining blood pressure in elderly - high systolic levels are undervalued with Korotkoff method.},
  url          = {http://dx.doi.org/10.1186/1471-2318-11-57},
  volume       = {11},
  year         = {2011},
}