There is scarce evidence for the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability, and arterial stiffness, in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24 h BP, BP variability, and arterial stiffness in a cohort of very elderly patients admitted to the hospital due to a decompensated chronic disease. We studied 249 patients older than 80 (66% women; 60% congestive heart failure). Noninvasive 24 h monitoring was used to determine 24 h brachial and central BP, BP and heart rate variabilities, aortic pulse wave velocity, and BP variability ratios during admission. The primary outcome was 1-year mortality. Aortic pulse wave velocity (3.3 times for each SD increase) and BP variability ratio (31% for each SD increase) were associated with 1-year mortality, after adjustments for clinical confounders. Increased systolic BP variability (38% increase for each SD change) and reduced heart rate variability (32% increase for each SD change) also predicted 1-year mortality. In conclusion, increased aortic stiffness and BP and heart rate variabilities predict 1-year mortality in very elderly patients with decompensated chronic conditions. Measurements of such estimates could be useful in the prognostic evaluation of this specific population.

Objective: There is scarce evidence of the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability and arterial stiffness in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24-hour BP, BP variability and arterial stiffness in a cohort of very elderly patients admitted to the hospital due to a decompensated chronic disease. Design and method: We studied 249 patients older than 80 (66% women), admitted due to a chronic disease decompensation (60% congestive heart failure). During admission, 24-hour brachial and central BP, BP and heart rate variabilities, aortic pulse wave velocity and BP variability ratio were determined through non-invasive 24-hour monitoring. The primary outcome was 1-year mortality. Secondary outcome was the composite of 1-year mortality or readmission. Results: Increased arterial stiffness (aortic pulse wave velocity and BP variability ratio) was associated with 1-year mortality. For each standard deviation (SD) increase in aortic pulse wave velocity and BP variability ratio, mortality increased 3.3 times and 31%, respectively, after adjustments for clinical confounders and BP. Increased BP variability (38% increase for each SD change) and reduced heart rate variability (32% increase for each SD change) also predicted 1-year mortality in fully adjusted models. No association was found between 24-hour BP (either brachial or aortic) and 1-year mortality. Conclusions: Increased aortic stiffness and BP and heart rate variabilities predict 1-year mortality in very elderly patients with decompensated chronic conditions. Measurements of such estimates could be useful in the prognostic evaluation of this specific population.

The prognostic value of BP elevation in very old patients with other chronic comorbidities is uncertain. We aimed to assess the prognostic impact of 24-hour BP (both brachial and central), BP variability, and pulse wave velocity (PWV) in very elderly patients hospitalized due to a chronic disease decompensation. We included 249 patients older than 80 years, admitted to the hospital due to decompensation of congestive heart failure (149), chronic obstructive pulmonary disease (60), chronic kidney disease with acute kidney injury (26), or other decompensated chronic conditions (14). During hospital stay, 24-h BP monitoring was performed (Mobil-O-Graph PWV). Mean values of brachial and central BP, aortic PWV, and BP variability (24-hour SD) were obtained in all participants. After discharge, patients were followed-up for one year. The primary outcome was total mortality. Hazard ratio (HR) of BP estimates (for 1 SD increase) were obtained through Cox models, adjusted for clinical confounders. During follow-up 72 patients (29%) died. Progression of heart failure (58%) was the most frequent cause of death. No differences were observed in 24-h BP between those who died or remained alive. Systolic BP-SD, and PWV were higher in patients who subsequently died, while 24-hour HR- SD was lower (Table). In fully adjusted models, PWV (HR: 3.54; 95%CI: 2.37-5.28), SD of 24-h brachial systolic BP (1.29; 1.00-1.67) and SD of 24-h heart rate (0.65; 0.46-0.91) were associated with the risk of mortality. We conclude that PWV, SBP and heart rate variabilities, but not the level of BP are associated with mortality in very old patients with advanced chronic conditions