Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Ambulatory not office blood pressure predicts mortality also in the elderly

Journal of Human Hypertension volume 33, pages 701–702 (2019)Cite this article

Subjects

Prevalence of hypertension increases with aging, even for those who had a normotensive middle age [1]. The elderly have become the fastest growing segment of the population in most if not all industrialized countries, with a prevalence hypertension approaching 90% at advanced life decades [2]. Therefore when we consider care of hypertension, we are facing increasing numbers of older patients. The well-known “white coat” phenomenon seems to be also more prominent in the elderly. Assuming that older individuals should have a greater experience with the medical environment, this is somewhat surprising, as repeated office measurements usually attenuate the “white coat” phenomenon, perhaps it has to do with negative life experience hence situational anxiety in the doctors’ offices [3, 4]. As the difference between office blood pressure (BP) and ambulatory BP monitoring (ABPM) values, which are loosely considered in this “white coat” phenomenon, is greater as office BP is higher, it is not clear if this is an age or BP effect. A recent publication from the huge Spanish ABPM registry [5] suggests that it is mostly BP rather than age effect. This “white coat” effect in the elderly had reached about 36 mmHg systolic BP in the Hypertension in the very elderly trial [6]. However such amazing differences appear repeatedly in the scarce ABPM studies devoted exclusively for elderly subjects, for example, 27 mmHg in the Syst-Eur trial [7], and 29 mmHg in Dublin Outcome Study [8]. Such differences could be one of the reasons why in observational studies relying on office BP in the very elderly BP does not predict mortality [2].

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D’Agostino RB, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham Heart Study. JAMA. 2002;287:1003–10.

    Article  Google Scholar 

  2. Stessman J, Bursztyn M, Gershinski Y, Rozenberg-Hammerman A, Jacobs JM. Hypertension and its treatment at age 90: is there an association with mortality? JAMDA. 2017;18:277e.13–19.

    Google Scholar 

  3. Ogedegbe G, Pickering TG, Clemow L, Chaplin W, Spruill TM, Albanese GM, et al. The misdiagnosis of hypertension: the role of patient anxiety. Arch Intern Med. 2008;168:2459–65.

    Article  Google Scholar 

  4. Ben-Dov IZ, Ben-Arie L, Mekler J, Bursztyn M. In clinical practice, masked hypertension is as common as isolated clinic hypertension: predominance of younger men. Am J Hypertens. 2005;18:589–93.

    Article  Google Scholar 

  5. Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Clinic versus daytime ambulatory blood pressure difference in hypertensive patients: the impact of age and clinic blood pressure. Hypertension. 2017;69:211–9.

    Article  CAS  Google Scholar 

  6. Bulpitt CJ, Beckett N, Peters R, Staessen JA, Wang JG, Comsa M, 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;61:89–94.

    Article  CAS  Google Scholar 

  7. Staessen JA, Thijs L, Fagard R, O’Brien ET, Clement D, de Leeuw PW, 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;282:539–46.

    Article  CAS  Google Scholar 

  8. Burr ML, Dolan E, O’Brien EW, O’Brien ET, McCormack P. The value of ambulatory blood pressure in older adults: the Dublin outcome study. Age Ageing. 2008;37:201–6.

    Article  Google Scholar 

  9. Cahan A, Ben-Dov IZ, Bursztyn M. The role of blood pressure variability in misdiagnosed clinic hypertension. Hypertens Res. 2011;34:187–92.

    Article  Google Scholar 

  10. Mancia G, Bombelli M, Cuspidi C, Facchetti R, Grassi G. Cardiovascular risk associated with white-coat hypertension: con side of the argument. Hypertension. 2017;70:668–75.

    Article  CAS  Google Scholar 

  11. Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378:1509–20.

    Article  Google Scholar 

  12. Ben-Dov IZ, Kark JD, Mekler J, Shaked E, Bursztyn M. The white coat phenomenon is benign in referred treated patients: a 14-year ambulatory blood pressure mortality study. J Hypertens. 2008;26:699–705.

    Article  CAS  Google Scholar 

  13. Pierdomenico SD, Pierdomenico AM, Coccina F, Porreca E. Prognosis of masked and white coat uncontrolled hypertension detected by ambulatory blood pressure monitoring in elderly treated hypertensive patients. Am J Hypertens. 2017;30:1106–11.

    Article  CAS  Google Scholar 

  14. Bjorklund K, Lind L, Zethelius B, Andrén B, Lithell H. Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation. 2003;107:1297–302.

    Article  Google Scholar 

  15. Franklin SS, Thijs L, Hansen TW, Li Y, Boggia J, Kikuya M, et al. International database on ambulatory blood pressure in relation to cardiovascular outcomes investigators. 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;59:564–71.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hypertension Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Mount-Scopus, P.O. Box 24035, 1924001, Jerusalem, Israel

    Michael Bursztyn

Authors
  1. Michael Bursztyn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Bursztyn.

Ethics declarations

Conflict of interest

The author declares that he has no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bursztyn, M. Ambulatory not office blood pressure predicts mortality also in the elderly. J Hum Hypertens 33, 701–702 (2019). https://doi.org/10.1038/s41371-019-0220-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-019-0220-0

Search

Advanced search

Quick links