Blood pressure behavior in the nursing home: Implications for diagnosis and treatment of hypertension

OBJECTIVES: To determine patterns of elevated blood pressure (BP) behavior, their clinical correlates, and the relationship to diagnosis and managemen t of hypertension. DESIGN: A cross-sectional, prevalence survey. SETTING: Forty-five nursing homes owned or managed by a large national chai n. PARTICIPANTS: A total of 857 older residents (mean age = 84 years). MEASUREMENTS: Supine and standing (1 and 3 minutes) BP and heart rate, take n four times in one day (before and after breakfast, and before and after l unch) by trained nurses using a random zero sphygmomanometer; medication pr ofile; active medical diagnoses; functional status; sociodemographics. RESULTS: The prevalence of a single, elevated, supine systolic pressure (gr eater than or equal to 160 mm Hg) was 14.3%, and of two to four elevated me asures was 14.9%. The pre-breakfast reading was consistently the highest, a nd mean systolic pressures decreased;after breakfast. Compared with those n ot treated, older residents taking antihypertensive medications had higher systolic pressures at all times and showed the same pattern of decline afte r breakfast. Isolated diastolic hypertension was uncommon (0.9%). Cardiovas cular disease, orthostatic hypotension, diabetes, and use of angiotensin co nverting 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 pr evalence of orthostatic hypotension. Diuretic use was more likely to be ass ociated with blood pressure control. CONCLUSION: The diagnosis of hypertens ion in frail older people would benefit from multiple, within-day measures, including postural BP, taken before and after meals. Diuretic use alone, o r in conjunction with ACE inhibitors or calcium channel blockers, was more likely to be associated with normalized blood pressures.