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Uncontrolled hypertension in older patients: markers and associated factors to masked and white-coat effect
Nereida Kc Lima1, Julio C Moriguti1, Eduardo Ferriolli1
1Division of General Internal Medicine & Geriatrics, Internal Medicine Department, Ribeirão Preto Medical School, São Paulo University, São Paulo, Brazil.
Insights
Masked uncontrolled hypertension in older adults is linked to higher pulse pressure and lower sleep blood pressure dipping. Ambulatory BP monitoring is crucial for accurate hypertension assessment in the elderly.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Hypertension Research
Background:
- Hypertension is a primary risk factor for cardiovascular diseases, disproportionately affecting over half the elderly population.
- Accurate assessment of hypertension control in older adults is critical for managing cardiovascular disease risk.
Purpose of the Study:
- To identify factors associated with masked uncontrolled hypertension and false uncontrolled hypertension in elderly patients.
- To evaluate the utility of office blood pressure measurements versus ambulatory blood pressure monitoring in older adults.
Main Methods:
- 273 elderly individuals (mean age 70.1 years) underwent office and 24-hour ambulatory blood pressure monitoring (ABPM).
- Patients were categorized into controlled (C), white-coat effect (WCE), uncontrolled (UC), and masked effect (ME) groups.
- Factors analyzed included age, BMI, diabetes, pulse pressure (PP), and sleep blood pressure dipping using Kruskal-Wallis and logistic regression.
Main Results:
- Older age was associated with the uncontrolled (UC) group compared to controlled (C) and masked effect (ME) groups.
- Higher 24-hour ABPM pulse pressure was observed in uncontrolled (UC) and masked effect (ME) groups.
- Lower sleep systolic blood pressure dipping was noted in the masked effect (ME) group compared to the controlled (C) group. Female gender was linked to the ME group, characterized by higher PP and lower sleep BP dipping.
Conclusions:
- Office blood pressure measurements alone are insufficient to differentiate white-coat effect (WCE) from uncontrolled (UC) hypertension or controlled (C) from masked effect (ME) hypertension in older individuals.
- Ambulatory blood pressure monitoring (ABPM) is superior for identifying higher pulse pressure and reduced sleep blood pressure dipping in masked effect and uncontrolled hypertension groups among the elderly.
Background:
Hypertension is the main risk factor for cardiovascular diseases, affecting more than half the elderly population. It is essential to know if they have proper control of hypertension. The aim of this study was to identify the associated factors to masked uncontrolled hypertension and false uncontrolled hypertension in older patients.
Methods:
Two-hundred seventy-three individuals (70.1 ± 6.7 years-old) had blood pressure (BP) measured at the office and by ambulatory BP monitoring (ABPM), with the definition of controlled group (C), individuals with high office BP and adequate ABPM, called white-coat effect group (WCE), uncontrolled (UC), and subjects with appropriate office BP and elevated ABPM denominated masked effect group (ME). Age, body mass index, diabetes, pulse pressure (PP) and BP dipping during sleep were evaluated (Kruskal-Wallis test and logistic regression models).
Results:
Age was higher in UC than in C and ME (P < 0.01), and 24-h ABPM PP was lower in C (48 ± 7 mmHg) and WCE (51 ± 6 mmHg) than in UC (67 ± 12 mmHg) and ME (59 ± 8 mmHg) (P < 0.01). Sleep systolic BP dipping was lower in ME than in C (P = 0.03). Female gender was associated with a greater chance of being of ME group, which showed a higher PP and lower BP dipping during sleep.
Conclusions:
In older individuals, office BP measurements did not allow the detection of associated factors that would permit to differentiate WCE from UC group and C from ME group. ABPM favored the identification of a higher PP and a lower BP dipping during sleep in the masked effect and uncontrolled groups.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.