Document Detail

Blood pressure behavior in the nursing home: implications for diagnosis and treatment of hypertension.
MedLine Citation:
PMID:  10078889     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine patterns of elevated blood pressure (BP) behavior, their clinical correlates, and the relationship to diagnosis and management of hypertension. DESIGN: A cross-sectional, prevalence survey. SETTING: Forty-five nursing homes owned or managed by a large national chain. PARTICIPANTS: A total of 857 older residents (mean age = 84 years). MEASUREMENTS: Supine and standing (1 and 3 minutes) BP and heart rate, taken four times in one day (before and after breakfast, and before and after lunch) by trained nurses using a random zero sphygmomanometer; medication profile; active medical diagnoses; functional status; sociodemographics. RESULTS: The prevalence of a single, elevated, supine systolic pressure (> or = 160 mm Hg) was 14.3%, and of two to four elevated measures was 14.9%. The pre-breakfast reading was consistently the highest, and mean systolic pressures decreased after breakfast. Compared with those not treated, older residents taking antihypertensive medications had higher systolic pressures at all times and showed the same pattern of decline after breakfast. Isolated diastolic hypertension was uncommon (0.9%). Cardiovascular disease, orthostatic hypotension, diabetes, and use of angiotensin converting enzyme inhibitors or calcium channel blockers were more prevalent among older residents who had elevated pressures on multiple occasions (P < .03). Successful antihypertensive treatment was associated with a lower prevalence of orthostatic hypotension. Diuretic use was more likely to be associated with blood pressure control. CONCLUSION: The diagnosis of hypertension in frail older people would benefit from multiple, within-day measures, including postural BP, taken before and after meals. Diuretic use alone, or in conjunction with ACE inhibitors or calcium channel blockers, was more likely to be associated with normalized blood pressures.
A Auseon; W L Ooi; M Hossain; L A Lipsitz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  47     ISSN:  0002-8614     ISO Abbreviation:  J Am Geriatr Soc     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-03-25     Completed Date:  1999-03-25     Revised Date:  2008-03-10    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  285-90     Citation Subset:  IM    
Research & Training Institute, Hebrew Rehabilitation Center for Aged, Boston, Massachusetts, USA.
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MeSH Terms
Aged, 80 and over
Antihypertensive Agents / therapeutic use
Blood Pressure Determination / methods*
Cross-Sectional Studies
Diuretics / therapeutic use
Drug Therapy, Combination
Frail Elderly*
Heart Rate
Hypertension* / diagnosis,  drug therapy,  physiopathology
Nursing Homes
Supine Position
Time Factors
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents; 0/Diuretics
Comment In:
J Am Geriatr Soc. 1999 Mar;47(3):373-4   [PMID:  10078905 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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