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

BMC Geriatrics, ISSN: 1471-2318, Vol: 11, Issue: 1, Page: 57
2011
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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. © 2011 Siennicki-Lantz and Elmståhl; licensee BioMed Central Ltd.

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