AUTOMATED BLOOD-PRESSURE MEASUREMENT (ABPM) IN THE ELDERLY

Application and feasibility of automated ambulatory blood pressure mea surement (ABPM) in the elderly are comparable to younger age groups. M ajor side-effects are sleep disturbances and pain during cuff-inflatio n. The main indications for ABPM are diagnosis and control of treatmen t in hypertensive patients. Further indications are the diagnosis of s yncope or hypotensive disorders and the diagnostic work-up of symptoms like vertigo, dizziness and dyspnea. In hypertensives, ABPM can easil y assess the ''white coat'' effect and cases of ''white coat'' hyperte nsion (prevalence in the elderly 15-25%). The prognostic implications of ''white coat'' hypertensions remain to be determined. Recording of the total 24-h blood pressure profile with analysis of circadian blood pressure changes, the day-night difference and the early morning surg e raises the possibility to assess age-specific patterns. The drop in blood pressure at night (during sleep) is usually decreased and less f requently observed in elderly hypertensives. Possible explanations inc lude decreased daytime activity, an altered sleep pattern in the elder ly and secondary forms of hypertension. So-called ''non-dippers'', wit h no adequate drop in night-time blood pressure, show a significant in crease in cardiovascular complications. Control of treatment via ABPM can assess non-responders and cases of overtreatment, and permits a fa irly objective analysis of side-effects. Episodes of transient myocard ial ischemia and possible trigger mechanisms can be assessed by simult aneous application of ABPM and Holter monitoring. The insufficient con trol of hypertension in the majority of elderly patients and the curre nt lower target blood pressures in the elderly call for new methods to improve the level and quality of antihypertensive treatment. Although ABPM provides a closer correlation to target organ damage than measur ement of office (casual) blood pressure, and ABPM frequently improves or at least facilitates the care of elderly hypertensive patients, it remains to be determined whether ABPM can finally improve the long-ter m outcome of these patients.