IN HOSPITAL DETECTION OF ELEVATED BLOOD PRESSURE (INDEBP TRIAL) - INTERIM ANALYSIS OF PROSPECTIVE COHORT: PREVALENCE OF HYPERTENSIVE AMBULATORY BLOOD PRESSURE

Objective: Elevated blood pressure (BP) is frequent in hospitalized patients, but its relationship to ambulatory BP measurements (ABPM) remains unclear. This study assessed the prevalence of hypertension in the ambulatory setting following hospital discharge in patients with elevated in-hospital BP. Design and method: Medical inpatients with at least 2 BP readings >=140/90 mmHg were included. Hospital BP was defined as the mean of these hypertensive readings. Exclusion criteria included symptomatic hypertension, BP >180/110 mmHg, hospitalization for acute cardiovascular conditions, and missing consent. Standardized BP measurements on the day of inclusion consisted of the mean of the 2nd/ 3rd measurement after 5 minutes of rest in a seated position. Four weeks post-discharge, all patients underwent 24-hour ABPM. Hypertension on ABPM was defined as a 24-hour mean BP >=130 or 80 mmHg. Cut-off values for awake and asleep periods were >=135/85 mmHg and >=120/70 mmHg, respectively. Statistical analyses used Wilcoxon signed-rank and chi-square tests. Results: Of 488 screened patients, 89 were included, and 52 completed ABPM. Median age was 71 (IQR 63 – 77) years with 36.5% female. Median (IQR) systolic/diastolic 24 h, awake, and asleep ABPM values were 134 (124 – 135) /82 (77 – 87), 136 (128 – 138) /85 (77 – 89), and 127 (116 – 140) /75 (69 – 82) mmHg, respectively. Thirty-seven patients (71.2%) had hypertensive BP in either systolic or diastolic 24-hour means, and 25 patients (48.1%) had hypertensive in both systolic and diastolic 24-hour means. Thirty-one patients (59.6%) had hypertensive systolic and 31 (59.6%) hypertensive diastolic 24-hour means, 27 (51.9%) and 28 patients (53.8%) hypertensive awake, and 34 (65.4%) and 38 (73.1%) hypertensive asleep periods. Among all patients, 11 (21.2%) showed no hypertension in ABPM, while 21 (40.4%) were consistently hypertensive across all periods. The comparison of patients with a hypertensive vs normotensive 24h-mean is shown in the table.Conclusions: A relevant proportion of patients with elevated BP in hospital show hypertension in ABPM. These findings underscore the need for follow-up BP monitoring in such patients to assess their risk of persistent hypertension in the ambulatory setting.