Clinical value of complex ambulatory monitoring of blood pressure and arterial rigidity in elderly patients

Aim. To study the clinical and diagnostic role of pulse wave time (PWT) in 24-hour blood pressure monitoring (BPM) and its link to elasticity of larger arteries and aorta (carotid-femoral pulse wave velocity, PWVcf, cardioankle vascular index, CAVI) in patients aged over 75 years. Material and methods. The study included 52 patients (20 men) aged over 75 years (mean age 79,1 3,5 years) with arterial hypertension (AH). Fifteen participants had cardiovascular events (CVE) in anamnesis: myocardial infarction, MI (n=11) or stroke (n=4). Sixteen patients had Functional Class II-III angina (n=16), and 32 received antihypertensive therapy. 24-hour BM P and PWT parameters were measured. Corrected PWT 100-60 was calculated for systolic BP (SBP) 100 mm Hg and heart rate (HR) 60 bpm. PWVcf and CAVI were assessed with a screening device VS 1000 VaSera, Fukuda Denshi, Japan. Results. In all participants, clinical BP level was 147,5 +/- 6,9/76,5 +/- 5,1 nim Hg; 24-hour BPM BP level - 139,6 +/- 6,7/70,7 +/- 4,6 mm Hg; PWT 100-60 - 161,7 +/- 6,2 ms; PVWcf - 17,3 +/- 4,6 m/s, and CAVI - 10,6 +/- 3,1. A significant negative correlation between PWT 100-60 and 24-hour BPM SBP (r=-0,36, p<0,05), 24-hour BPM PBP (r=-0,43, p<0,01), PWcf (r=-0,54, p<0,01) and CAVI (r=-0,34, p<0,05) was observed. Patients with and without CVE were comparable by age. CVE-free participants were characterised by lower frequency of antihypertensive therapy, higher levels of clinical BP (153,5 +/- 6,9/82,5 +/- 6,3 vs. 136,5 +/- 3,4/71,1 +/- 3,9 mm Hg), higher 24-hour BPM BP (144,0 +/- 6,9/73,2 +/- 5,3 vs. 132,6 +/- 4,2/69,3 +/- 3,8 mm Hg), lower PVWcf (15,8 +/- 4 vs. 18,7 +/- 4,4 m/s), lower CAVI (9,7 +/- 2,4 vs. 11,5 +/- 3,8), and higher PWT 100-60 (167 +/- 5,4 vs. 156,2 +/- 6,9 ms; p<0,05). Conclusion. In AH patients aged over 75 years, PWT 100-60 correlated with traditional indices of arterial rigidity. Lower PWT 100-60 and higher PWV were observed among individuals with CVE in anamnesis.