Image of Andrea Ungar, Ph.D.; Image credit: University of Florence
Andrea Ungar, M.D., Ph.D.; Image credit: University of Florence

Ambulatory blood pressure monitoring (ABPM) may reveal dangerous hypotensive episodes in long-term care facility residents, a new study finds. Such episodes might otherwise go unrecognized.

Long-term care residents are highly susceptible to hypotensive episodes — blood pressure dips that are a frequent cause of syncope and falls if not caught and addressed. The problem can be chronic, but symptoms can be atypical in this population, and residents with dementia may be less likely to report them. 

In the current study, investigators analyzed health data from 100 participants aged 60 and older to assess the prevalence of these episodes and blood pressure data. Participants had daytime hypotension and underwent ABPM. Hypotensive episodes were defined as systolic blood pressure drops of ≥20 mmHg between two consecutive measurements, reaching a minimum systolic blood pressure of <100 mmHg. 

The 50 residents who experienced hypotensive episodes during the study period had significantly lower ambulatory blood pressure than their peers who did not have episodes. They were also more likely to have higher nighttime blood pressure (reverse dipping) and a white coat effect (higher blood pressure when being seen by a clinician).

Overtreatment due to white coat effect

This results suggest that long-term care residents may have autonomic dysfunction caused by cardiovascular aging and comorbidities, reported Andrea Ungar, M.D., Ph.D., of Careggi Hospital and University of Florence in Italy. This may lead to higher blood pressure during the nighttime and orthostatic/postprandial hypotension during the daytime, he and his colleagues noted.

In addition, overtreatment may contribute to hypotensive episodes. This can be the result of the white coat effect, where residents who have higher blood pressure in the clinician’s office may receive excessive blood pressure lowering, they wrote.

“The present study confirms that [nursing home] residents have a significant predisposition for hypotensive episodes. ABPM can significantly contribute to hypotension diagnosis of subjects at risk in this vulnerable, older population,” the authors concluded.

Full findings were published in the Journal of the American Geriatrics Society.