Recently, new data from trials conducted on hypertension have been surging, leading to changes in the management of patients with arterial hypertension, and subsequently giving rise to modifications of practice guidelines. Yet, there is no consensus on the number of readings that should be considered to measure the accurate BP. The study aimed to determine the impact of age, gender, diabetes mellitus and hypertension on the systolic (SBP) and diastolic blood pressure (DBP) variability patterns in cardiac patients. Moreover, we highlighted the variability that occurs in percentage of patients diagnosed with hypertension according to different current guidelines Vs using mean of 5 consecutive BP readings.
1389 cardiac patients (median age, 54 (18, 87 y)) presenting at Alhyatt Heart and Vascular Center were studied. Five consecutive blood pressure measurements were taken, with one-minute interval. High SBP and DBP were classified according to the mean of the 5 readings as SBP >140 and DBP >90 mmHg according to different guidelines and SBP>130 and DBP>80 as per to new AHA/ACC cutoffs. Young subjects were defined as those <50y of age. A decrease in BP over 5 readings were defined as a difference between BP-reading 5 (R5) and R1 of -1 mmHg or more, while an increase was defined as R5-R1 ≥ 1 mmHg.
Number of patients diagnosed with hypertension varied among different guidelines and protocols, we found that this number was significantly altered when comparing different guidelines to the mean of five BP readings as follows: 560 (40.3%) patient as per to ESC (P < 0.001), 518 (37.3%) patient as per to CHEP (p < 0.001), 862 (62%) patients according to new AHA/ACC (p < 0.001). SBP decreased from R1 to R5 in 66% of patients by a mean of 6 mmHg. The decrease was greater in younger subjects (8 mmHg) compared to older patients (4 mmHg, P < 0.001). Sex, age, DM and hypertension significantly affected the SBP pattern. DBP declined in 55% of the population (mean decrease = 3 mmHg). Only hypertension and gender, but not DM or age affected the DBP pattern. The second reading of the SBP was notably higher than the other readings in hypertensive patients, diabetic patients, and older individuals with an average of 3–5 mmHg.
Subject characteristics such as age, gender, DM and HTN have an impact on blood pressure which might alter the diagnosis of hypertension. The study suggests that relying on the average of 5 BP measurements is more appropriate as the second reading often shows the greatest divergence based on subject characteristics and because 5 readings reflects an individual's daily life blood pressure variability more closely.
1Alhyatt Heart and Vascular Center, Alexandria, Egypt
2Department of cardiology, Tanta University Hospital, Tanta, Egypt
3Department of critical care Medicine, Alexandria University Hospital, Alexandria, Egypt
4Department of Physiology, Alexandria University, Alexandria, Egypt