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White coat effect and its clinical implications in the elderly.
Burcu Balam Yavuz1, Bunyamin Yavuz, Oyku Tayfur
1Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey. bbyavuz@hacettepe.edu.tr
Clinical and Experimental Hypertension (New York, N.Y. : 1993)
|October 9, 2009
Summary
White coat effect (WCE), common in elderly patients, is linked to daily activities and depression. Ambulatory blood pressure monitoring is crucial for accurate hypertension diagnosis in seniors.
Area of Science:
- Geriatric Medicine
- Cardiology
- Hypertension Research
Background:
- White coat effect (WCE) is a phenomenon where blood pressure is elevated in a clinical setting but normal outside of it.
- Accurate diagnosis of hypertension in the elderly is critical to prevent undertreatment and overtreatment.
- Office blood pressure readings alone may overestimate hypertension prevalence in geriatric populations.
Purpose of the Study:
- To determine the frequency of white coat effect (WCE) in elderly patients.
- To identify clinical factors, geriatric assessment scales, comorbidities, and laboratory results correlated with WCE in the elderly.
- To evaluate the necessity of ambulatory blood pressure monitoring (ABPM) for geriatric patients with elevated office blood pressure.
Main Methods:
- Sixty-one geriatric patients with normal baseline blood pressure but office readings exceeding 140/90 mmHg were included.
- All participants underwent 24-hour ambulatory blood pressure monitoring (ABPM).
- Correlations between WCE and various clinical parameters, geriatric assessment scales (e.g., ADL, IADL, GDS), comorbidities, and lab results were analyzed.
Main Results:
- A high frequency of white coat hypertension (WCH) was observed, with 72.1% of patients diagnosed with WCH.
- Systolic WCE was independently correlated with activities of daily living (ADL), instrumental activities of daily living (IADL) scores, and creatinine levels.
- Diastolic WCE was independently correlated with the Geriatric Depression Scale (GDS) score.
Conclusions:
- White coat hypertension is a significant contributor to office-diagnosed hypertension among geriatric patients.
- Factors such as functional status and renal function are associated with systolic WCE, while depression is linked to diastolic WCE.
- Ambulatory blood pressure monitoring (ABPM) is recommended for elderly patients with elevated office blood pressure to ensure accurate diagnosis and appropriate management, avoiding potential overtreatment.
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