Rapidly developing pseudohypertension after renal transplantation diagnosed by non-auscultated blood pressure measurement

Prevalence and clinical characteristics of pseudohypertension in elderly patients prepared for coronary artery angiography

BACKGROUND

Pseudohypertension (PHT) can cause adverse effects in the elderly owing to administration of antihypertension therapy. The present study aimed to determine the prevalence of PHT in the elderly and associated risk factors to investigate a noninvasive method of detection of PHT.

METHODS

We recruited 151 patients (age ≥60 years) who underwent coronary angiography. Demographic and clinical data were collected from the patients. During coronary angiography, intrabrachial arterial pressure and indirect blood pressure were measured. Brachial-ankle pulse wave velocity (ba-PWV) was measured within 2 weeks after coronary angiography.

RESULTS

Based on the differences between the direct and indirect pressure measurements, the patients were divided into a PHT group (n = 87) and a non-PHT group (n = 64). The prevalence of PHT was 57.6%, and the development of PHT was significantly associated with older age. Serum creatinine level and creatinine clearance rate were significantly higher in the non-PHT group than in the PHT group (P < .05). In addition, the PHT group had significantly higher ba-PWV and pulse pressure (PP) than the non-PHT group (P < .05). Receiver-operating characteristic curve analysis revealed that ba-PWV (AUC = 0.783) and PP (AUC = 0.791) showed a relatively good diagnostic performance for PHT.

CONCLUSIONS

PHT was present in most of the elderly who had indications for coronary angiography and associated with age and renal function. The data from the present study also suggested that both PP and ba-PWV could be used to positively predict PHT.

Pseudo-hypertension and arterial stiffness: a review

Hypertension is a condition of persistently elevated blood pressure, associated with increased cardiovascular risk. Non-invasive BP measurement using Korotkoff sounds is the most common method of screening for the condition. The possibility of inaccurate readings leading to a false diagnosis of hypertension (pseudo-hypertension) is of concern. Stiffened arteries in the elderly have been proposed as being the primary cause of pseudo-hypertension. Non-invasive detection of pseudo-hypertension remains problematic. This paper reviews clinical literature on pseudo hypertension and approaches to measuring the compressive stiffness of arteries, as well as biomechanical literature regarding models of arterial stiffness and the origin of Korotkoff sounds. Models of the latter show the importance of the relationship between transmural pressure and cross-sectional area (P1/Csa curve) of the brachial artery as it closes under the influence of the pressure cuff. The review concludes that future research on pseudo-hypertension should include development of new instrumentation to measure the P1/Csa curve of the brachial artery in vivo using non-invasive techniques suitable for application to an elderly population.