'KAIROS' project: ambulatory monitoring of blood pressure in community pharmacies. Monitoring and follow-up of blood pressure in hypertensive elderly patients under treatment

Objectives: Learning, through ambulatory blood pressure monitoring (AMBP) in community pharmacies (CP), the level of blood pressure (BP) monitoring in hypertensive elderly patients. Identification of circadian profile. Identification of isolated clinical hypertension (ICH) and hidden uncontrolled hypertension (HUH). Methods: Consecutive sampling of hypertensive elderly patients with antihypertensive drug treatment attended to at two CPs. Isolated measuring of blood pressure in a community pharmacy (IMCP) and AMBP were conducted over at least 29 hours in each patient. The report was sent to the doctor for evaluation. Results: 219 patients (47.9% females, aged 71.5 +/- 5.4 years on average). The level of control with IMCP measurement (74 patients) is 34% and with AMBP (99 patients) is 45%. The prevalence of the dipper circadian rhythm was 29.7%. 21 hypertensive patients controlled with IMCP (140/90) (9.6%) had BP values of >= 130/80 in AMBP 24h, and/or >= 135/85 in AMBP activity and/or >= 120/70 night time AMBP, considering patients with hidden uncontrolled hypertension (HUH). 46 hypertensive uncontrolled patients in IMCP (>= 140/90) (21%) had BP values of 130/80 in AMBP 24h and <135/85 in AMBP activity and <120/70 night time AMBP, considering patients with isolated clinical hypertension (ICH). Conclusions: The level of BP control of hypertensive elderly patients is higher when measured with AMBP. Its circadian profile is mostly non dipper. AMBP measurement in CPs allows identification of ICH and HUH. Isolated BP measurements are not sufficient to optimize HBP control in these patients.