Benefits of Treatment in the Elderly
People whose elevated blood pressure is diagnosed as white-coat hypertension (WCH) are typically told by their health care providers that they don't need treatment. That's because their blood pressure rises only when it's measured during a visit with the doctor and is normal when measured at home. The phenomenon of WCH is thought to result from tension or anxiety about seeing the doctor.
However, new findings from a study of hypertension in older adults indicate that WCH in people older than 80 may not be so harmless after all and treatment for the condition may be beneficial. The study suggests that WCH may be associated with increased risk of a cardiovascular event such as a stroke or a heart attack.
The findings are from a small sub-study of a larger, randomized clinical trial, the Hypertension in the Very Elderly Trial (HYVET), which evaluated the effect of antihypertensive drug treatment in nearly 3,500 patients over age 80 with high blood pressure. The sub-study, reported in the January 2013 issue of Hypertension, looked at 112 patients who had WCH.
The participants' readings averaged 140/80 mm Hg for readings taken in the morning by an ambulatory blood pressure monitor (a device worn by a patient for 24 to 48 hours that records blood pressure at 15- to 60-minute intervals). When taken in a clinician's office, their readings averaged 172/90 mm Hg, a considerable difference of 32/10 mm Hg. Normal blood pressure for most healthy adults is considered to be lower than 120/80 mm Hg.
HYVET found that people with hypertension who took blood pressure–lowering drugs reduced their risk of stroke by as much as 30 percent, their risk of a cardiovascular event by 34 percent and their risk of premature death from any cause by 21 percent. The sub-study suggests that 40 to 60 percent of HYVET participants may have had WCH and therefore patients with WCH may benefit from taking antihypertensive drugs.
Past studies have shown that the presence of WCH increases with age. But the researchers suggest that perhaps the term "white-coat hypertension" should no longer apply to the very elderly, especially since national guidelines don't advise treating people for WCH. They point to the need for more clinical trials on WCH. Because this study was small, its findings need to be confirmed in a larger group.
Elevated blood pressure damages the body's blood vessels and organs, leading to heart attack, heart failure, kidney damage and stroke. If you're over 80 and your doctor suggests white-coat hypertension may be causing your high in-office blood pressure readings, ask whether you might benefit from drug treatment and other measures to reduce blood pressure, such as exercise, weight loss or dietary strategies.
Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50