255Superior Risk Stratification is Obtained from Ambulatory Blood Pressure Monitoring in Older Irish Adults

Background: Older people have an increased risk for cardiovascular disease such as Stroke). The prevalence of hypertension is very significant in this population. Hypertension-lowering medications reduce the risk for such events. However, routine clinic blood pressure reading (CBPM) can be inaccurate and misleading in diagnosing hypertension. Therefore, the use of these medications can be detrimental in the older population who do not need them. We reviewed the data of a subgroup of patients over the age of 65 from the ABPM Population Study Ireland (APSI study) who had Ambulatory blood pressure monitoring (ABPM) in the primary care setting. Methods: ABPM recordings performed in the primary care clinic setting between January 1999 and June 2012 for the indication of raised CBPM were examined using the dabl ABPM primary care module. Ethical approval was obtained from the local hospital ethics board and all data were anonymised. Results: Twenty-seven thousand, seven hundred and sixty-seven (27,767) patients over the age of 65 had valid day-time and night-time blood pressure (BP) readings and were included in the review. Average age was 75.4 (SD 9.8), and 56.3% were females. Fifty-two point six percent (SD 15.3) of the population had sustained hypertension and 28.1% have white coat hypertension. When the data was analysed for dippings, 18% (SD 17.4) had reversed-dipping, 32.6% (SD 15.7) were non-dippers and about 14.7% (SD 15.2) were extreme dippers. Conclusion: ABPM is becoming indispensable in the risk stratification of some complex older adults. It allows for greater individualisation of therapy. As identified above, some people with white coat hypertension do not need BP lowering medications while those with elevated night-time BP need better 24 hour control. None of this will be evident if our management is based merely on clinic blood pressure readings.