Blood Pressure Variability in Elderly Persons With White-Coat and Masked Hypertension Compared to Those With Normotension and Sustained Hypertension

Abstract

The relationship between blood pressure (BP) measured, its variability, and risk of cardiovascular events is well established; however, it is not well known whether there is a difference of variability between the four categories of BP status obtained by the comparison of office and home BP measurements: normotension and masked, white-coat, and sustained hypertension. Here, we assessed BP variability (BPV) according to BP status in the elderly. The study population consisted of 1,701 individuals aged ≥73 years drawn from the general population. Office and home BP measurements were obtained with the same device. At home, 18 measures were taken (3 in the morning, 3 in the evening, for 3 consecutive days). BP statuses were defined according to European Society of Hypertension recommendations. To assess BPV, seven indexes were defined (e.g., standard deviation of the 18 measures, day-to-day variability, triplet-to-triplet variability, and coefficient of variation). Subjects with white-coat hypertension and normotension had similar BPV, and the variability among those with masked hypertension was very close to that in those with sustained hypertension. Overall, BPV was much higher in subjects with masked hypertension than in those with white-coat hypertension, in both treated and untreated groups. In elderly individuals, the short-term variability of BP is similar in masked and sustained hypertension and higher than in normotension and white-coat hypertension. This result suggests the hypothesis that BPV among persons with masked hypertension may contribute to the elevated cardiovascular risk observed in this BP pattern.