To Investigate the Prevalence of White Coat Hypertension in Community Dwelling Older Adults Referred for a Falls Assessment

Abstract

Abstract Background Falls and frailty are the main focus in our integrated care programme for older persons (ICPOP). Office blood pressure (OBP) measurements are commonly used in practice although out of office recordings are proven to be a better predictor of cardiovascular risk (Myers et al, 2018). The European Society of Cardiology guidelines (ESC, 2018) have proposed BP values for the classification of hypertension (HTN). Methods We retrospectively completed a chart review on older adults’ who attended ICPOP with a referral for a falls assessment from November 2021 to April 2024. OBP were obtained after the patient was in the hub for approximately one hour following their comprehensive geriatric assessment (CGA). The OBP was documented following a supine period of 5 minutes. We compared the OBP and ambulatory blood pressure monitor (ABPm) average readings to assess the prevalence of HTN based on the ESC guidelines. Results 75 charts were reviewed. 3 ABPm recordings were unsuccessful due to cognitive impairment or not tolerating the ABPm. These were excluded from the audit. No patient had hypotension on either their OBP or ABPm recordings. On their OBP recordings, 29/72 (40%) had a normal reading while 43/72 (60%) had HTN. On their ABPm 54/72 (75%) had a normal reading while 18/72 (25%) had HTN. When we looked at antihypertensive medication use in those who had a normal reading on their ABPm, 47/54 (87%) were on antihypertensive treatment. All patients with HTN on their ABPM were on antihypertensive treatment. Conclusion Our findings suggest that OBP readings greatly increase the numbers of patients diagnosed with HTN compared to ABPm (60% versus 25%). Therefore, we suggest that all patients should have an ABPm as a gold standard to falls assessment to avoid over-treating white coat HTN.