Blood Pressure Variability Provides Useful and Prognostic Information on the White‐Coat Effect Among Older Patients

Abstract

Tanner and colleagues 1 with great interest. They aimed to determine the white-coat effect (WCE) and investigate the prevalence of white-coat hypertension (WCH) among younger and older adults. The authors concluded that clinic systolic blood pressure (SBP) was higher than outof-clinic SBP among participants 60 years and older vs those younger than 60 years and that clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white-coat effect. According to the results, the authors provide suggestions about the role of ambulatory blood pressure (BP) monitoring in guiding antihypertensive treatment, elevated clinic BP, lower out-of-clinic BP, and white-coat effect among older adults. 1Ambulatory BP monitoring not only provides information on BP level but also on the diurnal changes in BP.2-6 Both daytime and nighttime BP consistently predicted the composite endpoint of all cardiovascular events. Twenty-four-hour ambulatory BP monitoring is the best way of excluding white-coat hypertension in patients with higher BP measurements in the doctor's office. It is also known that 24-hour BP is superior to only one BP measurement in the association of target organ damage and in the prediction of future cardiovascular events and mortality, 7-9 which is currently recommended by the latest guideline of the European Society of Hypertension.10 Through 24-hour BP monitoring, BP variability (BPV) can be derived and provide significant prognostic information, independent of mean BP.BP is not a constant condition so it may be affected by mental and physical activity and sleep. BP changes from moment to moment in response to autonomic, humoral, mechanical, myogenic, and environmental stimuli should be noted.2 BP measurement may be affected by several factors such as smoking, temperature, emotional stress, and environmental stimuli. In order to investigate the effects of these factors on BP levels, BPV is a good tool obtained by visit-to-visit or ambulatory monitoring. There are some parameters needed in order to define BPV such as standard deviation (SD) of day-night and 24-hour BP, coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV) derived from ambulatory BP monitoring. 9,10 There are some reports and meta-analyses on the relationship between BPV and all-cause mortality. In a recent study, it was shown that visit-to-visit systolic BP variability, independent of age and mean systolic BP, was a predictor of cardiovascular and all-cause mortality and stroke. In an another study, the predictive value of visit-to-visit systolic BPV namely SD, CV, VIM, and ARV for cardiovascular events and all-cause mortality was shown. It was reported that a 1 mm Hg increase in SD was significantly associated with a 3% higher risk of all-cause mortality, a 10% higher risk of cardiovascular mortality, and a 2% higher risk of stroke. A 1% increase in CV was significantly associated with a 4% higher risk of all-cause mortality, a 1% higher risk of cardiovascular mortality, and a 5% higher risk ...

Masked Hypertension and Left Atrial Dysfunction: A Hidden Association

“…ABPM could provide true and prognostic information on BP variability in hypertensive patients . Recent analysis shows important prognostic value of BP variability, assessed by 24‐hour ABPM, in white‐coat hypertension among older patients …”