Usefulness of orthostatic blood pressure in the diagnosis of white coat hypertension in elderly patients

• Published in: American journal of hypertension 2002-04, Vol.15 (4), p.A86-A86
• Main Authors: Amado, Paula, Carmona, José, Vasconcelos, Nuno, Almeida, Lurdes, Santos, Isabel, Silveira, Conceição, Nazaré, José
• Format: Article
• Language: English
• Subjects: Erderly Patients; Orthostatic Blood Pressure; White Coat Hypertension
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/S0895-7061(02)02508-6

White coat hypertension (WCH) is associated to a small cardiovascular risk. It's very frequent among older people and do not need pharmacological treatment. Until now only Ambulatory Blood Pressure Monitoring (ABPM) can diagnose it. We wanted to know if there were clinical parameters that could differentiate WCH from sustained hypertensive (HT) patients in an older population. Design and Methods: Between 1999-2001 we propectively studied, 93 untreated elderly hypertensives (71±8, 53% males), in the office, by clinical examination and by ECG, ABPM (Spacelabs 90207), Vascular Distensibility (Complior-Colson), EcoDoppler (Esaote AV3 Partner) studies. We analysed supine BP (SBP), orthostatic BP (OBP) one minute after, and the difference between supine and orthostatic BP (DBP), Ambulatory BP (ABP), pulse wave velocity (PWV) and EcoDoppler parameters. The results were compared with a control group of 20 normotensive (NT) individuals (67± years old, 55% males). Results: we found by ABPM that 28 (30%) pts were whitecoat hypertensives (WCH), 71±8 years old, 53% males, SBP:169±16/86±mmHg and 24 h ABP 128 ±/72±mmHg. Conclusions: It can be concluded that in the absence of a significant fall in orthostatic blood pressure in an older patient with office hypertension we should suspect of white coat hypertension. This simple measurement can avoid the pharmacological treatment initiation in a low risk population. (See Table) NT (N = 20) WCH (28) HT (65) p SBP 143 ± 12 169 ± 16 176 ± 22 0,000 OBP 141 ± 11 169 ± 17 169 ± 22 0,000 ABP 0,7 ± 11;* 0 ± 11 −7 ± 15 0,03 24h sys ABP 122 ± 8 128 ± 5 149 ± 19 0,000 *NS