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Is white coat hypertension innocent? Structure and function of the heart in the elderly
I Kuwajima1, Y Suzuki, A Fujisawa
1Division of Cardiology, Tokyo Metropolitan Geriatric Hospital, Japan.
Insights
White coat hypertension in older adults is linked to heart changes, including enlarged atria and impaired diastolic function. However, systolic heart function reserve remains preserved, suggesting it
Area of Science:
- Cardiology
- Geriatrics
- Hypertension Research
Background:
- White coat hypertension (WCH) is characterized by elevated office blood pressure with normal out-of-office readings.
- The long-term cardiovascular impact of WCH, particularly in elderly populations, requires further investigation.
Purpose of the Study:
- To assess cardiac morphological and functional characteristics in elderly patients with WCH.
- To compare these characteristics against those with true hypertension and normotensive controls.
Main Methods:
- Echocardiographic study of 67 elderly individuals (>60 years): 17 with WCH, 34 with true hypertension, 16 controls.
- Isometric handgrip exercise test to evaluate left ventricular (LV) functional reserve.
- Measurements included left atrial dimension, LV mass index, and diastolic function parameters.
Main Results:
- WCH group showed significantly greater left atrial dimension and LV mass index than normotensive controls.
- LV diastolic function was progressively impaired from normotension to WCH to true hypertension.
- LV systolic functional reserve was maintained in the WCH group during handgrip exercise.
Conclusions:
- Elderly patients with WCH exhibit moderate increases in left atrial dimension and LV mass.
- A tendency towards disturbed diastolic function exists in WCH, despite preserved systolic reserve.
- These cardiac alterations suggest WCH in the elderly may have significant clinical implications.
Abstract:
To evaluate the morphological and functional characteristics of the heart in elderly patients with white coat hypertension, we performed an echocardiographic study in 67 elderly individuals older than 60 years: 17 patients with white coat hypertension, 34 patients with true hypertension, and 16 normotensive control subjects. White coat hypertension was defined as a mean 24-hour ambulatory systolic blood pressure of less than 140 mm Hg associated with office hypertension. Cardiac responses to an isometric handgrip exercise test were used to evaluate left ventricular functional reserve. Left atrial dimension and left ventricular mass index were significantly greater in the white coat hypertension group than in the normotension group (P < .05) but were similar to values in the true hypertension group. Left ventricular diastolic function, expressed by peak late-early filling ratio of diastolic mitral flow, showed increasing impairment in the order of the normotension, white coat hypertension, and true hypertension groups (analysis of variance, P < .05); the ratio in the white coat hypertension group tended to be higher than that in the normotension group (unpaired t test, P = .054). The relation between fractional shortening and end-systolic stress did not shift downward after handgrip exercise in the white coat hypertension group, indicating that functional reserve in the left ventricle was maintained. Thus, patients with white coat hypertension had a moderately increased left atrial dimension and left ventricular mass in association with a tendency for disturbed diastolic function, although systolic functional reserve remained the same. These findings suggest that white coat hypertension in the elderly may not be innocent.