SOME CONSIDERATIONS ON BLOOD PRESSURE PATTERNS IN A MENTAL HOSPITAL POPULATION

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Abstract
Much can be gained by considering blood pressure patterns and by classifying them into at least 4 groups. For example, only by a consideration of the pattern formed by securing multiple measures on each patient could a labile-borderline grouping be reliably distinguished. Although the criteria used for this diagnosis were somewhat arbitrary, the finding that over 15% of all hospitalized patients showed such patterns can still be regarded with a fair degree of confidence. Because of the possible connection between these blood pressure states and an autonomic impairment, further study of the labile groups would appear to be highly desirable. However, all mental patients were not characterized by such variable blood pressure readings; rather, measurements of schizophrenics classified as normotensive indicate that daily[long dash]and indeed, even their hourly[long dash]blood pressure readings fluctuated to a degree approaching that of normals. Of course, use of a 4-way blood pressure classification did tend to restrict variabilities, since a number of patients diagnosed as labile-borderline would otherwise have been classified as normotensive and thereby have raised the pooled standard deviations found for the individuals comprising the normotensive category. Blood pressure patterns were found to be related to age, with hypertension and lability more frequent among older patients, while hypotension was much greater among patients under the age of 46. Even when the present data were adjusted to comply with Master''s criteria, abnormal blood pressure classifications were still evident in a surprisingly high proportion of institutionalized patients. The relatively high incidence of hypotensive patterns suggests that this state might occur even more frequently among hospitalized patients than has been previously reported. Whether this is an effect brought about by the fact thatinstitutionalized patients are more prone toward inactivity as Monroe suggests, or by some still-undertermined factors, is a question which has long eluded investigators. While no definite link between abnormal profiles and psychotropic drug administration was established in this survey, the data in no way precluded such a possibility. Indeed, if abnormal blood pressure should prove indicative of diffuse autonomic impairment, as some clinicans suspect, patients with such patterns might be expected to have more frequent side-reactions to such drugs. It may be emphasized also that for the physician contemplating drug therapy or considering a patient''s possible response to anesthesia and surgery, knowledge of the patient''s blood pressure pattern may prove to be of considerable value.

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