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Titolo:
Intra-individual postural blood pressure variability and stroke in elderlynursing home residents
Autore:
Hossain, M; Ooi, WL; Lipsitz, LA;
Indirizzi:
Vet Adm Med Ctr W Roxbury, Massachusetts Vet Epidemiol Res & Informat Ctr,Boston, MA 02132 USA Vet Adm Med Ctr W Roxbury Boston MA USA 02132 at Ctr,Boston, MA 02132 USA Hebrew Rehabil Ctr Aged, Res & Training Inst, Boston, MA 02131 USA Hebrew Rehabil Ctr Aged Boston MA USA 02131 ng Inst, Boston, MA 02131 USA Harvard Univ, Sch Med, Div Aging, Boston, MA 02115 USA Harvard Univ Boston MA USA 02115 Sch Med, Div Aging, Boston, MA 02115 USA Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA Beth Israel Deaconess Med Ctr Boston MA USA 02215 d, Boston, MA 02215 USA
Titolo Testata:
JOURNAL OF CLINICAL EPIDEMIOLOGY
fascicolo: 5, volume: 54, anno: 2001,
pagine: 488 - 494
SICI:
0895-4356(200105)54:5<488:IPBPVA>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
ORTHOSTATIC HYPOTENSION; HYPERTENSION; HEALTH; RISK;
Keywords:
orthostatic blood pressure variability; stroke; clinical algorithm; frail elderly;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
19
Recensione:
Indirizzi per estratti:
Indirizzo: Ooi, WL Hlth Care Consult & Anal, 8 Deforest Rd, Newton, MA 02462 USA HlthCare Consult & Anal 8 Deforest Rd Newton MA USA 02462 462 USA
Citazione:
M. Hossain et al., "Intra-individual postural blood pressure variability and stroke in elderlynursing home residents", J CLIN EPID, 54(5), 2001, pp. 488-494

Abstract

Orthostatic hypotension (OH) is a potential risk factor for adverse cardiovascular events, but OH is highly variable and may not be detected on a single occasion. To assess the relation between intra-individual variability of systolic orthostatic blood pressure change (Delta SBP) and cardiovascularoutcomes, an algorithm was developed to identify Delta SBP instability using repeated supine and standing BP measurements. A cohort of 673 nursing home residents underwent baseline postural. BP measurements (supine to 1 minute of standing, four times in a single day) and were followed for up to 2 years. Two groups (stable vs. unstable) were identified based on an analysisof Delta SBP variance components. Differences in outcomes were compared via Cox survival analysis. At baseline 12.6% were unstable, defined as a one standard deviation difference of at least 20.2 mmHg between Delta SBP readings. Unstable subjects were more likely to have OH on at least one measurement (systolic BP drop of 20 mmHg or more; 85% vs. 36%, respectively) and tobe on psychotropic medication at baseline (47% vs 35%) (P-values <0.001). Other characteristics (including previous stroke) did not differ. During a mean follow-up of 10.3 months, stroke incidence was higher in unstable subjects (13.1% vs. 4.9%; P = 0.012), but ischemic heart disease and mortality rates were not significantly different (respectively, 13.5% vs. 7.4%, P = 0.115; 14.8% vs. 10.7%, P = 0.178). Survival analyses (adjusted far age, sex, psychotropic medications, body mass index, ischemic heart disease, and supine systolic pressure) confirmed a higher risk of stroke in unstable subjects (relative risk = 3.7, 95% CI: 1.6-8.4). Highly variable orthostatic BP measures may reflect impaired BP regulatory mechanisms in elders with occult cerebrovascular disease, or may directly affect cerebral blood now. Orthostatic BP Variability may be a better indicator of future stroke than a single supine or orthostatic change measure. (C) 2001 Elsevier Science Inc. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 01:39:48