Nocturnal Blood Pressure Dipping is Abolished in Old-Elderly Hospitalized Patients

Introduction During sleep there is reduction of blood pressure (BP) caused by a decrease of the sympathetic nervous tone. This nocturnal “dipping” phenomenon, assessable with ambulatory blood pressure monitoring (ABPM), is blunted with increasing age. Aim To assess the effect of hospitalization on night-time BP fall in old-elderly patients. Methods We analysed 78 ABPM of old-elderly hospitalized patients (mean age 91 ± 0.5 years) and those of 18 outpatients as control group. The nocturnal BP fall was assessed calculating: the dipping value (DV) i.e. the difference between mean diurnal systolic BP (mDSBP) and mean nocturnal systolic BP (mNSBP) and the “dipping pattern” i.e. mNSBP/mDSBPx100. Results Hospitalized patients showed a lower rate of normal dipping patterns (9 vs. 39%), an higher rate of reverse dippers (59 vs. 28%; p < 0.05) and a lower DV (−0.9 ± 1 vs. 9 ± 4 mmHg; p < 0.05) than patients of control group. At multivariate regression analysis including age, gender and hospitalization, DV was significantly correlated only with the hospitalization ( β −0.3, t −2.9; p < 0.05). Conclusions In old-elderly hospitalized patients nocturnal BP fall is abolished. This enhancement of the age related reduction of nocturnal BP dipping may be due to the stress associated with hospital environment.