Difficulty With Hearing And Blood Pressure In Geriatric Adults
Overview
This cross-sectional study aimed to explore the relationship between hearing function, as measured by pure-tone average (PTA) of air conduction thresholds, and 24-hour ambulatory blood pressure (BP) in older adults. Conducted among 1404 community-dwelling individuals aged 65 years and above from the Seniors-ENRICA cohort, the study utilized various methods to assess hearing loss and BP patterns.
Hearing loss was defined based on PTA thresholds exceeding 40 decibels (dB-aHL) in the better ear across different frequency ranges. Circadian BP patterns were calculated, and participants were categorized as dippers, nondippers, or risers. Ambulatory hypertension criteria were established, incorporating BP measurements and antihypertensive treatment status.
The analyses, adjusted for confounders, revealed significant associations between PTA and nighttime systolic BP, with hearing impairment at standard and speech frequencies showing consistent associations. Among hypertensive individuals, hearing loss at standard and high-frequency PTA was linked with the riser BP pattern, indicating a higher likelihood of nocturnal BP elevation. Additionally, standard PTA hearing loss was associated with uncontrolled nighttime BP in this subgroup.
In conclusion, the study highlights the relationship between hearing impairment and nocturnal BP disturbances in older hypertensive individuals. These findings underscore the potential importance of assessing hearing function as part of cardiovascular risk stratification in this population, suggesting avenues for further research and potential clinical implications.
Introduction
Hypertension, commonly known as high blood pressure, represents a significant global health challenge affecting more than 1.28 billion individuals worldwide. Its impact extends beyond mere numbers, as hypertension stands as a leading risk factor for disability-adjusted life years and mortality rates. While historically associated with low and middle-income regions, hypertension prevalence has surged in recent decades, doubling in these areas. Notably, even high-income countries have not been spared, as evidenced by declines in hypertension control, particularly notable in the United States. Despite efforts to curb its prevalence, progress has been limited, prompting a reevaluation of prevention and management strategies.
Clinical guidelines, such as those from Europe and America, play a pivotal role in guiding healthcare professionals in managing hypertension. These guidelines, periodically updated, offer valuable insights into associated pathologies and treatment modalities. However, despite their comprehensiveness, they often overlook sensory impairments, such as hearing loss, which can have profound implications for individuals with hypertension.
The relationship between hypertension and hearing loss remains a topic of ongoing debate within the scientific community. While some studies suggest a correlation between elevated blood pressure levels and auditory impairment, others have failed to establish a clear association. This discrepancy underscores the complexity of the relationship and the need for further investigation.
Age-related conditions, including disability, frailty, and dementia, have been linked to both hearing loss and hypertension, suggesting potential shared mechanisms. However, the precise nature of these relationships remains poorly understood, highlighting the need for more comprehensive studies.
To address these knowledge gaps, our study aimed to examine the association between air-conduction hearing thresholds and blood pressure patterns in hypertensive individuals. By employing pure-tone average measurements and ambulatory blood pressure monitoring, we sought to provide a more nuanced understanding of the interplay between hearing loss and hypertension. Specifically, we aimed to elucidate how different patterns of blood pressure control over a 24-hour period may impact auditory function.
Through our research, we hope to contribute to a better understanding of the complex relationship between hypertension and hearing loss. By examining objective measures and patterns of blood pressure control, we aim to provide valuable insights that can inform future prevention and management strategies for individuals with hypertension and sensory impairments.
Method
The Seniors‐ENRICA‐2 study stands as a pivotal endeavor in the realm of geriatric research, focusing on a cohort of community-dwelling individuals aged 65 years and above in the urban landscape of Madrid and its surrounding environs. With meticulous attention to detail, the study’s inception in 2015 saw the implementation of a sophisticated sampling strategy, stratified by both sex and district, ensuring representation across demographic and geographical spectra.
A noteworthy aspect of the study is its recent 2019 data collection phase, where the research framework was bolstered by the addition of new measures, including the assessment of hearing function and ambulatory blood pressure monitoring (ABPM). This expansion underscored the study’s commitment to evolving with scientific advancements and addressing emerging research questions pertinent to aging populations.
Informed by ethical guidelines and under the auspices of the clinical research ethics committee of La Paz University Hospital in Madrid, participants provided voluntary written consent, thus upholding the principles of autonomy and beneficence in research conduct.
Within this robust analytical framework, a subset of 1404 participants underwent comprehensive hearing assessments using AudCal, a cutting-edge application designed for iPhone and iPad. This innovative tool enabled precise determination of air conduction thresholds across various frequencies, thereby facilitating the identification of hearing impairment with unparalleled accuracy. Notably, the assessment protocol adhered to rigorous standards, ensuring reliability and validity in the obtained data.
Simultaneously, the study employed the Mobil‐O‐Graph 24‐hour PWA monitor for ABPM, enabling continuous blood pressure monitoring over a 24-hour period. This sophisticated technology provided invaluable insights into the circadian dynamics of blood pressure regulation, offering a nuanced understanding of cardiovascular health in the aging population.
In addition to these core assessments, a comprehensive array of covariates was meticulously evaluated, encompassing demographic factors, lifestyle variables, and prevalent health conditions. This multifaceted approach enabled researchers to delineate complex associations between hearing function, blood pressure dynamics, and various determinants of health and well-being in older adults.
By integrating state-of-the-art assessment tools, rigorous methodological protocols, and a comprehensive analytical framework, the Seniors‐ENRICA‐2 study emerges as a cornerstone in geriatric research. Its findings hold the potential to inform evidence-based interventions aimed at promoting healthy aging, enhancing quality of life, and mitigating the burden of age-related health conditions in older populations.
Statistical Analysis
The study aimed to explore the relationship between hearing status and various health parameters, including blood pressure (BP), cognitive function, lifestyle factors, and comorbidities. Initially, differences in sociodemographic characteristics, lifestyle habits, comorbidities, and cognitive function were assessed across different categories of hearing status using statistical tests such as the unpaired Student’s t-test and the χ2 test.
To estimate the association between pure-tone audiometry (PTA) and BP, linear regression models were employed, adjusting for potential confounders in three successive models. The first model adjusted for age and gender, while the second model included additional adjustments for educational level, smoking status, alcohol consumption, dietary habits, physical activity, body mass index (BMI), sleep duration, television viewing time, and other factors. The third model further adjusted for specific comorbidities, cognitive status, occupational noise exposure, hearing aid usage, and presence of tinnitus.
Furthermore, logistic regression models were utilized to calculate odds ratios (ORs) for the association between moderate to profound hearing loss and circadian BP patterns, as well as uncontrolled hypertension. The definition of “uncontrolled” hypertension was based on specific BP thresholds. These logistic models were adjusted for the same confounders as the linear regression models.
The statistical analyses were conducted using Stata software, version 16.1, provided by Stata Corp. This comprehensive approach aimed to elucidate the complex interplay between hearing status and various health parameters while meticulously controlling for potential confounding factors, thereby contributing to a deeper understanding of the associations observed in the study population.
Result
In this study encompassing 1404 participants, the majority being men (53.5%) with a mean age of 73.6 years, the prevalence of hypertension varied concerning different definitions of hearing loss. Among those with hearing loss, whether at standard pure-tone audiometry (PTA), speech frequency PTA, or high-frequency PTA, the prevalence of 24-hour hypertension ranged from 71.7% to 76.2%. Comparatively, participants with hearing loss were older and exhibited lower tobacco use, poorer dietary habits, increased sedentary behavior, and higher rates of diabetes, cardiovascular disease, and cognitive impairment. They also reported more workplace noise exposure, although less exposure to loud music, increased hearing aid usage, and more frequent tinnitus.
Surprisingly, no significant associations were found between PTA across different frequency ranges and 24-hour systolic or diastolic blood pressure (SBP/DBP), or SBP/DBP during the daytime. However, an association was observed between standard and speech frequency PTA and SBP during nighttime, even after adjusting for various confounding factors. Furthermore, all three PTA frequencies correlated with DBP during nighttime, albeit to varying degrees.
In hypertensive individuals, hearing loss at standard and high-frequency PTA was linked with the “riser” blood pressure pattern, indicating a steeper rise in BP during the night. Additionally, those with hearing loss at standard PTA were more prone to uncontrolled nighttime BP.
These findings underscore the intricate relationship between hearing loss and hypertension, particularly concerning nighttime blood pressure regulation. The study highlights the importance of considering hearing impairment as a potential factor influencing hypertension management and underscores the need for further research in this area to better understand and address these complex associations.
Conclusion
The study focused on investigating the relationship between hearing loss and blood pressure (BP) patterns, particularly during nighttime, in a community-dwelling older adult population. Notably, the research observed a significant correlation between hearing impairment, particularly at standard and speech frequencies, and higher nighttime BP levels. This association persisted even after adjusting for various potential confounding factors, including sociodemographic variables, lifestyle behaviors, comorbidities, cognitive function, and other hearing-related parameters.
One intriguing finding was the identification of a “riser” BP pattern among hypertensive individuals with hearing loss, indicating an elevated risk of cognitive impairment and cardiovascular events. The prevalence of 24-hour hypertension within this cohort was considerable, emphasizing the importance of recognizing potential risk factors like hearing impairment for cardiovascular health management.
Despite not finding a substantial link between hearing loss and BP levels throughout the entire day, the study underscored the significance of monitoring nighttime BP, which has been shown to be a superior predictor of cardiovascular outcomes compared to daytime measurements. This underscores the importance of assessing nighttime BP, particularly in individuals with hearing impairment, to better understand their cardiovascular risk profile.
The study also hinted at a potential shared mechanism involving inflammation, which could underlie both hearing loss and hypertension. This suggests a complex interplay between these conditions, warranting further investigation into common underlying pathways.
Strengths of the study included its use of precise measures of auditory function and ambulatory BP monitoring, providing a comprehensive assessment of BP patterns in real-life settings. However, the cross-sectional design limited the ability to establish causality definitively, highlighting the need for longitudinal studies to confirm these associations and elucidate underlying mechanisms.
In summary, the study’s findings underscore the importance of considering hearing loss as a potential risk factor for elevated nighttime BP and related cardiovascular complications in older adults. Further research is warranted to better understand the underlying mechanisms and long-term implications of these associations, ultimately informing preventive strategies and interventions to mitigate cardiovascular risk in this population.
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