Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Hypertension Reports
Published in: Current Hypertension Reports 11/2015

01-11-2015 | Prevention of Hypertension: Public Health Challenges (P Muntner, Section Editor)

The Utility of Ambulatory Blood Pressure Monitoring for Diagnosing White Coat Hypertension in Older Adults

Authors: Kristi Reynolds, C. Barrett Bowling, John J. Sim, Lakshmi Sridharan, Teresa N. Harrison, Daichi Shimbo

Published in: Current Hypertension Reports | Issue 11/2015

Login to get access

Abstract

The beneficial effect of antihypertensive medication on reducing the risk of cardiovascular disease (CVD) events is supported by data from randomized controlled trials of older adults with hypertension. However, in clinical practice, overtreatment of hypertension in older adults may lead to side effects and an increased risk of falls. The diagnosis and treatment of hypertension is primarily based on blood pressure measurements obtained in the clinic setting. Ambulatory blood pressure monitoring (ABPM) complements clinic blood pressure by measuring blood pressure in the out-of-clinic setting. ABPM can be used to identify white coat hypertension, defined as elevated clinic blood pressure and non-elevated ambulatory blood pressure. White coat hypertension is common in older adults but does not appear to be associated with an increased risk of CVD events among this population. Herein, we review the current literature on ABPM in the diagnoses of white coat hypertension in older adults, including its potential role in preventing overtreatment.
Literature
1.
Fuster V. Cardiovascular disease in the elderly: a challenge for science and clinical care. Nat Clin Pract Cardiovasc Med. 2005;2(11):549.CrossRefPubMed
2.
Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746–53.CrossRefPubMed
3.
Lawes CM, Vander Hoorn S, Rodgers A, International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513–8.CrossRefPubMed
4.
Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension. 2007;49(1):69–75.CrossRefPubMed
5.
Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111(5):697–716.CrossRefPubMed
6.
Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.CrossRefPubMed
7.
Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354(22):2368–74.CrossRefPubMed
8.
O’Brien E, Parati G, Stergiou G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31(9):1731–68.PubMed
9.
Franklin SS, Thijs L, Hansen TW, O’Brien E, Staessen JA. White-coat hypertension: new insights from recent studies. Hypertension. 2013;62(6):982–7.CrossRefPubMed
10.
Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. JACC. 2011;57(20):2037–114.CrossRefPubMed
11.
Ishikawa J, Ishikawa Y, Edmondson D, Pickering TG, Schwartz JE. Age and the difference between awake ambulatory blood pressure and office blood pressure: a meta-analysis. Blood Press Monit. 2011;16(4):159–67.CrossRefPubMed
12.
Stergiou GS, Ntineri A, Kollias A. Changing relationship among office, ambulatory, and home blood pressure with increasing age: a neglected issue. Hypertension. 2014;64(5):931–2.CrossRefPubMed
13.•
Nesti N, Pieraccioli M, Mossello E, et al. Tolerability of ambulatory blood pressure monitoring (ABPM) in cognitively impaired elderly. Blood Press. 2014;23(6):377–80. This study demonstrated that ABPM was generally tolerated among 176 cognitively impaired patients aged 65 years and older. Only 16% of patients wore the device less than 24 hours and the number of valid ABPM measurements was still close to the minimum required.CrossRefPubMed
14.•
Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: an updated systematic review for the U.S. Preventive Services Task Force. Annals Intern Med. 2015;162(3):192–204. This systematic review found that repeated blood pressure measurements may improve the diagnostic accuracy of office blood pressure measurement. Further, that initially elevated office blood pressure should be confirmed by ambulatory blood pressure monitoring to avoid overdiagnosis of isolated clinic hypertension.CrossRef
15.
Fagard RH, Celis H, Thijs L, et al. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension. 2008;51(1):55–61.CrossRefPubMed
16.
Hansen TW, Kikuya M, Thijs L, et al. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals. J Hypertens. 2007;25(8):1554–64.CrossRefPubMed
17.
Boggia J, Li Y, Thijs L, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet. 2007;370(9594):1219–29.CrossRefPubMed
18.
Ward AM, Takahashi O, Stevens R, Heneghan C. Home measurement of blood pressure and cardiovascular disease: systematic review and meta-analysis of prospective studies. J Hypertens. 2012;30(3):449–56.CrossRefPubMed
19.
Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA. 1988;259(2):225–8.CrossRefPubMed
20.
Pickering TG, Gerin W, Schwartz JE, Spruill TM, Davidson KW. Franz Volhard lecture: should doctors still measure blood pressure? The missing patients with masked hypertension. J Hypertens. 2008;26(12):2259–67.PubMedCentralCrossRefPubMed
21.
Pickering TG, Davidson K, Gerin W, Schwartz JE. Masked hypertension. Hypertension. 2002;40(6):795–6.CrossRefPubMed
22.
Kario K. Morning surge in blood pressure and cardiovascular risk: evidence and perspectives. Hypertension. 2010;56(5):765–73.CrossRefPubMed
23.
Peacock J, Diaz KM, Viera AJ, Schwartz J, Shimbo D. Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates, and future directions. J Hum Hypertens. 2014;28(9):521–8.PubMedCentralCrossRefPubMed
24.
Turner JR, Viera AJ, Shimbo D. Ambulatory blood pressure monitoring in clinical practice: a review. Am J Med. 2015;128(1):14–20.CrossRefPubMed
25.
Mancia G, Verdecchia P. Clinical value of ambulatory blood pressure: evidence and limits. Circ Res. 2015;116(6):1034–45.CrossRefPubMed
26.•
Franklin SS, Thijs L, Hansen TW, et al. Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in relation to cardiovascular outcomes population. Hypertension. 2012;59(3):564–71. This meta-analysis included individuals from the 11-country IDACO population database. Cardiovascular risk in untreated individuals with white-coat hypertension was similar to the risk in untreated normotensive individuals.PubMedCentralCrossRefPubMed
27.
Kario K, Shimada K, Schwartz JE, Matsuo T, Hoshide S, Pickering TG. Silent and clinically overt stroke in older Japanese subjects with white-coat and sustained hypertension. JACC. 2001;38(1):238–45.CrossRefPubMed
28.
Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Am J Hypertens. 2011;24(1):52–8.CrossRefPubMed
29.
Verdecchia P, Reboldi GP, Angeli F, et al. Short- and long-term incidence of stroke in white-coat hypertension. Hypertension. 2005;45(2):203–8.CrossRefPubMed
30.
Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47(5):846–53.CrossRefPubMed
31.
Zanchetti A, Mancia G. Longing for clinical excellence: a critical outlook into the NICE recommendations on hypertension management—is nice always good? J Hypertens. 2012;30(4):660–8.CrossRefPubMed
32.••
Tanner RM, Shimbo D, Seals SR, et al. White-coat effect among older adults: data from the Jackson Heart Study. J Clin Hypertens. 2015. doi:10.​1111/​jch.​12644. Data from 257 participants in the Jackson Heart Study with elevated clinic blood pressure underwent ambulatory blood pressure monitoring. Clinic systolic blood pressure was higher than daytime out-of-clinic blood pressure and this white-coat effect was larger for participants 60 years and older vs. participants less than 60 years of age.
33.••
Bulpitt CJ, Beckett N, Peters R, et al. Does white coat hypertension require treatment over age 80?: Results of the hypertension in the very elderly trial ambulatory blood pressure side project. Hypertension. 2013;61(1):89–94. These findings from this study suggest that a systolic blood pressure ≥125 mmHg on 24-h ambulatory blood pressure monitoring may require treatment in adults older than 80 years.CrossRefPubMed
34.
Staessen JA, Thijs L, Fagard R, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA. 1999;282(6):539–46.CrossRefPubMed
35.
Mancia G, Omboni S, Parati G, et al. Twenty-four hour ambulatory blood pressure in the hypertension optimal treatment (HOT) study. J Hypertens. 2001;19(10):1755–63.CrossRefPubMed
36.
37.
Dasgupta K, Quinn RR, Zarnke KB, et al. The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2014;30(5):485–501.CrossRefPubMed
38.
Krause T, Lovibond K, Caulfield M, McCormack T, Williams B, Guideline Development G. Management of hypertension: summary of NICE guidance. BMJ. 2011;343:d4891.CrossRefPubMed
39.
Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens. 2014;32(1):3–15.CrossRefPubMed
40.
41.••
Shimbo D, Kent ST, Diaz KM, et al. The use of ambulatory blood pressure monitoring among Medicare beneficiaries in 2007-2010. J Am Soc Hypertens. 2014;8(12):891–7. This study demonstrated that ambulatory blood pressure monitoring use among Medicare beneficiaries between 2007 and 2010 was very low in the USA, and it was not being used to diagnose white coat hypertension.CrossRefPubMed
42.
Staessen JA, Byttebier G, Buntinx F, Celis H, O’Brien ET, Fagard R. Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators. JAMA. 1997;278(13):1065–72.CrossRefPubMed
43.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.CrossRefPubMed
44.
Bangalore S, Messerli FH, Wun CC, et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J. 2010;31(23):2897–908.CrossRefPubMed
45.
Kovesdy CP, Bleyer AJ, Molnar MZ, et al. Blood pressure and mortality in U.S. veterans with chronic kidney disease: a cohort study. Annals Intern Med. 2013;159(4):233–42.CrossRef
46.•
Sim JJ, Shi J, Kovesdy CP, Kalantar-Zadeh K, Jacobsen SJ. Impact of achieved blood pressures on mortality risk and end-stage renal disease among a large, diverse hypertension population. JACC. 2014;64(6):588–97. This retrospective study of nearly 400,000 treated hypertensive patients found that patients with systolic and diastolic blood pressures in the ranges of 130–139 mmHg and 60–79 mmHg, respectively, had the lowest risk for mortality and end-stage renal disease.PubMedCentralCrossRefPubMed
47.
Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575–85.CrossRefPubMed
48.
49.
Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172(22):1739–44.CrossRefPubMed
50.••
Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174(4):588–95. During an average follow-up of 3 years in the Medicare Current Beneficiary Survey cohort, 9.0 % of adults aged 70 years and older experienced a serious fall injury. Further, antihypertensive medications were associated with an increased risk of serious fall injuries.PubMedCentralCrossRefPubMed
51.
Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60.CrossRefPubMed
52.•
Margolis KL, Palermo L, Vittinghoff E, et al. Intensive blood pressure control, falls, and fractures in patients with type 2 diabetes: the ACCORD trial. J Gen Intern Med. 2014;29(12):1599–606. In a subset of 3,099 participants aged 40–79 years of the Action to Control Cardiovascular Risk in Diabetes randomized trial, intensive antihypertensive treatment that lowered systolic blood pressure to <120 mmHg was not associated with increased risk of falls.CrossRefPubMed
53.
Peters R, Beckett N, Burch L, et al. The effect of treatment based on a diuretic (indapamide) +/− ACE inhibitor (perindopril) on fractures in the Hypertension in the Very Elderly Trial (HYVET). Age Ageing. 2010;39(5):609–16.CrossRefPubMed
54.
Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Med Clin North Am. 2015;99(2):281–93.CrossRefPubMed
55.
56.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.CrossRefPubMed
57.
King MB, Tinetti ME. Falls in community-dwelling older persons. J Am Geriatr Soc. 1995;43(10):1146–54.CrossRefPubMed
Metadata
Title
The Utility of Ambulatory Blood Pressure Monitoring for Diagnosing White Coat Hypertension in Older Adults
Authors
Kristi Reynolds
C. Barrett Bowling
John J. Sim
Lakshmi Sridharan
Teresa N. Harrison
Daichi Shimbo
Publication date
01-11-2015
Publisher
Springer US
Published in
Current Hypertension Reports / Issue 11/2015
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-015-0599-0

Other articles of this Issue 11/2015

Current Hypertension Reports 11/2015 Go to the issue

Pathogenesis of Hypertension (W Elliott, Section Editor)

Clinical Significance of Endothelial Dysfunction in Essential Hypertension

Hypertension and the Kidney (RM Carey, Section Editor)

Current Approaches to Quantifying Tonic and Reflex Autonomic Outflows Controlling Cardiovascular Function in Humans and Experimental Animals

Prevention of Hypertension: Public Health Challenges (P Muntner, Section Editor)

Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV

Preeclampsia (V Garovic, Section Editor)

Preeclampsia: Syndrome or Disease?

Hypertension and the Brain (S Stocker, Section Editor)

Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits