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"White coat" hypertension and alerting reaction in elderly and very elderly hypertensive patients
P Trenkwalder1, M Plaschke, I Steffes-Tremer
1Department of Internal Medicine, Starnberg Hospital, Germany.
Insights
White coat hypertension, a phenomenon where blood pressure is elevated in clinical settings, affects 18% of elderly hypertensive patients. These patients exhibit less cardiac damage and a stronger alerting response compared to those with definite hypertension.
Area of Science:
- Gerontology
- Cardiology
- Hypertension Research
Background:
- "White coat" hypertension (WCH) is observed in 20-25% of younger hypertensive patients.
- The prevalence and characteristics of WCH in elderly populations are less understood.
- Elevated blood pressure in older adults necessitates careful evaluation to distinguish between true hypertension and WCH.
Purpose of the Study:
- To determine the frequency of "white coat" hypertension (WCH) in untreated elderly hypertensive patients.
- To assess the "white coat" effect (alerting reaction) in this demographic.
- To compare cardiovascular parameters between WCH and "definite" hypertension in the elderly.
Main Methods:
- Ambulatory blood pressure monitoring (ABPM), ECG, and echocardiography were performed on 50 untreated hypertensive patients aged 70 years and older.
- Patients were categorized into "white coat" hypertension (daytime ABPM ≤ 146/87 mmHg) and "definite" hypertension (daytime ABPM > 146/87 mmHg) groups.
- Left ventricular mass index and ECG criteria for hypertrophy were assessed.
Main Results:
- 18% of elderly patients had WCH, 56% had "definite" hypertension, and 26% were in an intermediate group.
- WCH patients had lower office blood pressure, lower left ventricular mass index, and no ECG-defined left ventricular hypertrophy compared to "definite" hypertensives.
- WCH patients demonstrated a more pronounced alerting reaction (mean difference: 39/22 mmHg) than "definite" hypertensives (mean difference: 27/8 mmHg).
Conclusions:
- "White coat" hypertension and a significant alerting reaction are present in untreated elderly and very elderly hypertensive individuals.
- Elderly patients with WCH show milder hypertension, less cardiac target organ damage, and a greater alerting response.
- The prognostic implications of WCH in the elderly require further investigation in larger cohorts.
Abstract:
"White coat" hypertension can be demonstrated in 20-25% of younger patients with mild-to-moderate hypertension. In a population of 50 untreated hypertensive patients > or = 70 years (mean age 79 +/- 6 years, office blood pressure > or = 160 mmHg systolic and > or = 95 mmHg diastolic) ambulatory blood pressure monitoring, ECG and echocardiography were performed to assess the frequency of "white coat" hypertension and the alerting reaction ("white coat" effect). "White coat" hypertension was diagnosed, if mean daytime ambulatory blood pressure was < or = 146/87 mmHg (taken as upper "normal" limit), "definite" hypertension, if > 146/87 mmHg. Nine patients (18%) were classified as "white coat", 28(56%) as "definite" hypertensives, 13(26%) as an "intermediate" group. There were no differences in gender, weight, concomitant diseases, pre-study treatment, and systolic or diastolic left ventricular function between the groups. Patients with "white coat" hypertension showed lower office blood pressure (178 +/- 13/98 +/- 3 vs 201 +/- 19/104 +/- 7 mmHg; p < 0.004), lower left ventricular mass index (131 +/- 9 vs 139 +/- 26 g/m2, p < 0.5), no left ventricular hypertrophy (ECG-criteria; p < 0.05), a more pronounced alerting reaction (39 +/- 13/22 +/- 5 vs 27 +/- 17/8 +/- 9; p < 0.01) and no correlation between office blood pressure and left ventricular mass compared to the "definite" hypertension group. The total group showed an average alerting reaction of 30 +/- 19/12 +/- 8 mmHg. It is concluded that "white coat" hypertension and an alerting reaction can be demonstrated in untreated elderly and very elderly hypertensive patients. Patients with "white coat" hypertension are characterized by a milder degree of hypertension, less cardiac target organ damage and a more pronounced alerting reaction. The prognostic significance of "white coat" hypertension in the elderly needs to be reevaluated in a larger population.