Masked hypertension in the elderly: cross-sectional analysis of a population-based sample

Prevalence of masked and white-coat hypertension among individuals with diabetes: insights from web-based home blood pressure monitoring in the Brazilian population

The association between diabetes mellitus (DM) and masked hypertension (MH) in ambulatory blood pressure (BP) monitoring is established, but its relationship with home BP monitoring (HBPM) remains uncertain. This web-based database study compared BP phenotypes in individuals using (n = 51,194; 6.05% with DM) and not using (n = 55,320; 0.63% with DM) antihypertensive medications (AH) undergoing HBPM. Multivariable logistic regression analysis revealed similar MH and white-coat hypertension (WCH) prevalence in individuals with or without DM, irrespective of AH use. However, among AH non-users, DM was associated with a higher likelihood of normotension (OR 1.35, 95%CI 1.09-1.66; p = 0.006) and a lower likelihood of sustained hypertension (OR 0.77, 95%CI 0.60-0.99; p = 0.039) compared to individuals without DM. These findings suggest that while DM does not significantly impact MH and WCH in HBPM, it may influence normotension and sustained hypertension rates in AH non-users. Likelihood of diabetes mellitus according to blood pressure phenotypes. AH - antihypertensive medications; CH - controlled hypertension; MH - masked hypertension; MUCH - masked uncontrolled hypertension; NT - normotension; SH - sustained hypertension; SUCH - sustained uncontrolled hypertension; WCH - white-coat hypertension; WUCH - white-coat uncontrolled hypertension.

Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis

Aim: Whether exaggerated blood pressure response (EBPR) to exercise represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. We investigated this issue through a review and a meta-analysis of studies providing data on this association in normotensive individuals undergone both to dynamic or static exercise and to 24 h blood pressure monitoring (ABPM). Design: A systematic search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 31 December 2022. Studies were identified by using the following search terms: “masked hypertension”, “out-of-office hypertension”, “exercise blood pressure”, “exaggerated blood pressure exercise”, “exercise hypertension”. Results: Nine studies including a total of 387 participants with MH and 406 true normotensive controls were considered. Systolic BP (SBP) and diastolic BP (DBP) at rest were significantly higher in MH individuals than in sustained normotensives: 126.4 ± 1.4/78.5 ± 1.8 versus 124.0 ± 1.4/76.3 ± 1.3 mmHg (SMD: 0.21 ± 0.08, CI: 0.06–0.37, p = 0.007 for SBP; 0.24 ± 0.07, CI: 0.08–0.39, p = 0.002 for DBP). The same was true for BP values at peak exercise: 190.0 ± 9.5/96.8 ± 3.7 versus 173.3 ± 11.0/88.5 ± 1.8 mmHg (SMD 1.02 ± 0.32, CI: 0.39–1.65, p = 0.002 for SBP and 0.97 ± 0.25, CI: 0.47–1.96, p < 0.0001 for DBP). The likelihood of having an EBPR was significantly greater in MH than in their normotensive counterparts (OR: 3.33, CI: 1.83–6.03, p < 0.0001). Conclusions: Our meta-analysis suggests that EBPR reflects an increased risk of MH and that BP measurement during physical exercise aimed to assess cardiovascular health may unmask the presence of MH. This underscores the importance of BP measured in the medical setting at rest and in dynamic conditions in order to identify individuals at high cardiovascular risk due to unrecognized hypertension.

Medical Telemonitoring for the Management of Hypertension in Older Patients in Japan

Hypertension is the most frequent modifiable risk factor associated with cardiovascular disease (CVD) morbidity and mortality. Even in older people, strict blood pressure (BP) control has been recommended to reduce CVD event risks. However, caution should be exercised since older hypertensive patients have increased physical vulnerability due to frailty and multimorbidity, and older patients eligible for clinical trials may not represent the general population. Medical telemonitoring systems, which enable us to monitor a patient's medical condition remotely through digital communication, have become much more prevalent since the coronavirus pandemic. Among various physiological parameters, BP monitoring is well-suited to the use of such systems, which enable healthcare providers to deliver accurate and safe BP management, even in the presence of frailty and/or living in geographically remote areas. Furthermore, medical telemonitoring systems could help reduce nonadherence to antihypertensive medications and clinical inertia, and also enable multi-professional team-based management of hypertension. However, the implementation of medical telemonitoring systems in clinical practice is not easy, and substantial barriers, including the development of user-friendly devices, integration with existing clinical systems, data security, and cost of implementation and maintenance, need to be overcome. In this review, we focus on the potential of medical telemonitoring for the management of hypertension in older people in Japan.

Self-Monitoring Home Blood Pressure in Community-Dwelling Older People: Age Differences in White-Coat and Masked Phenomena and Related Factors—The SONIC Study

Some studies reported that home blood pressure (HBP) monitoring was conducted by community-dwelling older people themselves, but there have been few studies on HBP including very old populations aged over 90 years old. Thus, the aim of the present study was to clarify the current situation of white-coat and masked phenomena defined by on-site and home BP measurements in community-dwelling old and oldest-old populations. The study subjects were 380 participants from the SONIC study, a cohort study of a community-dwelling old population, who measured their HBP in a series of 3–5 days by themselves and brought their HBP records to the venue on the survey day. Study participants' characteristics were as follows: female, 185 (48.7%); male, 195 (51.3%); 70s, 95 (25.0%); 80s, 245 (64.5%); and 90s, 40 (10.5%). A total of 344 (90.5%) participants had hypertension. A total of 291 (76.6%) hypertensive participants taking antihypertensive medication were analyzed in the present study. Regarding the types of hypertension defined by home and on-site BP, they showed white-coat phenomenon, 183 (48.2%); masked phenomenon, 115 (30.3%); sustained hypertension, 130 (34.2%); and normotension, 82 (21.6%). On comparison of age groups, there was a tendency for the white-coat phenomenon to be common in young-old people in their 70s and the masked phenomenon to be common in very old people in their 90s. Therefore, since the detection of white-coat and masked phenomena is closely associated with appropriate BP management, it is very important for community-dwelling older populations to self-monitor HBP.

The Key Role of Ambulatory Blood Pressure Monitoring in the Detection of Masked Hypertension and Other Phenomena in Frail Geriatric Patients

Background and Objectives: This study aims to determine prevalence of masked uncontrolled hypertension (MUH) in frail geriatric patients with arterial hypertension and thus show the role of ambulatory blood pressure monitoring (ABPM) since hypertension occurs in more than 80% of people 60+ years and cardiovascular diseases are the main cause of death worldwide. Despite modern pharmacotherapy, use of combination therapy and normal office blood pressure (BP), patients’ prognoses might worsen due to inadequate therapy (never-detected MUH). Materials and Methods: 118 frail geriatric patients (84.2 ± 4.4 years) treated for arterial hypertension with office BP < 140/90 mmHg participated in the study. 24-h ABPM and clinical examination were performed. Results: Although patients were normotensive in the office, 24-h measurements showed that BP values in 72% of hypertensives were not in the target range: MUH was identified in 47 (40%) patients during 24 h, in 48 (41%) patients during daytime and nocturnal hypertension in 60 (51%) patients. Conclusions: ABPM is essential for frail geriatric patients due to high prevalence of MUH, which cannot be detected based on office BP measurements. ABPM also helps to detect exaggerated morning surge, isolated systolic hypertension, dipping/non-dipping, and set and properly manage adequate treatment, which reduces incidence of cardiovascular events and contributes to decreasing the financial burden of society.

From Clinical Trials to Bedside: the Use of Antihypertensives in Aged Individuals. Part 1: Evaluation and Evidence of Treatment Benefit

PURPOSE OF REVIEW

Use of antihypertensives in older adults can be complicated by the potential for undesired effects on comorbidities, adverse effects of the drugs, and overall medication burden. The purpose of this two-part review is to discuss contemporary issues encountered in the management of hypertension in aged individuals, with a particular focus on the individualization of treatment. In part 1, we discuss the evaluation of the aged hypertensive patient and review the clinical trial evidence for treatment benefit of hypertension in the elderly.

RECENT FINDINGS

Elderly patients with suspected hypertension need careful evaluation of their blood pressure, as errors in measurement technique, inaccurate devices, or overreliance on office blood pressure readings may lead to under- or over-treatment, thereby increasing risks of adverse medication effects and/or cardiovascular events. Epidemiologic evidence in older adults suggests a link between low blood pressure and increased mortality. However, key prospective hypertension trials such as HYVET and SPRINT, which were focused in mostly healthy, community-dwelling elderly cohorts, have unequivocally demonstrated benefits of lowering blood pressure in reducing cardiovascular events in the very elderly. Recent evidence also suggests benefit in reducing the risks of cognitive impairment. Hypertension is a major modifiable risk factor and the benefits of treatment in lowering cardiovascular events are realized for most individuals, even at advanced ages.

Blood Pressure Measurements with Different Currently Available Methods in Elderly Hypertensive Hospitalized Patients: A Real World Cross-Sectional Study

BACKGROUND

The reliability of blood pressure (BP) measurement in hospitalized patients is a topic of debate and the therapeutic implication of the routinely collected BP profiles is probably overestimated. When measurements are performed in elderly patients, further potential sources of misinterpretation occur.

METHODS

We conducted a subanalysis of a previous study including 79 over 80-year-old hypertensive patients, hospitalized in an internal medicine ward. Five modalities of BP evaluations (measurement by physicians and nurses, self-measurement by patients, Finometer® beat-to-beat finger monitoring, and 24h monitoring) were analyzed, considering agreement and accuracy.

RESULTS

The mean (SD) age of the patients was 86.9±4.9 years (50% women). Patients' self-measurements of both systolic and diastolic BP (SBP and DBP) did not differ significantly from daytime 24-hour monitoring (D24hBPM) (mean difference -1.52, SE 1.71; p: ns and -0.58, SE 1.19 mmHg; p: ns). Conversely, SBP and DBP registered by nurses did significantly differ (mean difference -7.34, SE 1.42; p=0.007 and -4.7, SE 1.05 mmHg; p=0.003). SBP and DBP measured by patients also showed the better concordance, with lowest biases, and narrowest limits of agreements (LoA) and for SBP higher Kappa statistic values (bias 1.5, LoA -28.9 to 31.9; κ 0.563 and bias 0.6, LoA -20.4 to 21.5 mmHg; κ 0.412). The patients' sensitivity and specificity in predicting hypertensive systolic D24hBPM were 84.8% and 69.7%, respectively.

CONCLUSIONS

In elderly hospitalized patients an alternative to 24hBPM, self-measurements by patients offer the better agreement and reliability in detecting hypertensive values.

Management of hypertension in older people

INTRODUCTION

As the population ages, the prevalence of hypertension is increasing. Treatment of hypertension is associated with a reduction in cardiovascular risk. However, the optimal blood pressure targets in older people are not clearly defined due to paucity of randomised clinical trials specific to this age group.

AREAS COVERED

We performed a Medline and Embase search from 1998 to present for articles on the management of hypertension in older people published in English language.

EXPERT COMMENTARY

The recent guidelines have suggested a lower blood pressure target of less than 130/80 mmHg. Due to the heterogeneity of older people, this universal low target may not be applicable to all of them. Targets based on functional level rather than chronological age are more appropriate. Special considerations in older people such as increased prevalence of frailty, falls, dementia, polypharmacy and the predominance of isolated systolic hypertension should also be taken into account. Tighter control, if well tolerated, is suitable for the fit person but relaxed targets are more reasonable in individuals with physical or cognitive decline. Therefore, in older people, targets should be individualised putting quality, rather than quantity, of life at the heart of their care plans.

Untreated Masked Hypertension and Subclinical Cardiac Damage: A Systematic Review and Meta-analysis

AIM

Data on the association of masked hypertension (MH) (i.e., normal office and elevated out-of-office blood pressure (BP)) with cardiac damage are scanty. We performed a meta-analysis in order to provide a comprehensive information on subclinical cardiac alterations in subjects with MH.

DESIGN

Studies were identified by the following search terms: "masked hypertension," "white coat normotension," "isolated ambulatory hypertension," "left ventricular mass," "left ventricular hypertrophy," "cardiac damage," and "echocardiography." Full articles published in English language providing data on left ventricular (LV) mass and/or prevalence of LV hypertrophy in MH, as assessed by ambulatory BP monitoring, were considered.

RESULTS

Overall, 4,884 untreated subjects (2,467 normotensive, 776 MH, and 1,641 sustained hypertensive individuals) of both genders included in 12 studies were analyzed. LV mass index showed a progressive increase from normotensive (79.2 ± 0.35 g/m(2)) to MH (91.6 ± 4.0 g/m(2)) (standard difference in means (SDM): 0.50 ± 0.11, confidence interval (CI): 0.28-0.73, P < 0.01) and to hypertensive subjects (102.9 ± 3.3g/m(2)) (SDM: 0.22 ± 0.07, CI: 0.09-0.35, P < 0.01). After assessing data for publication bias, the difference between groups was still significant.

CONCLUSIONS

Our findings support an association between MH and increased risk of LV structural alterations compared to true normotensive individuals. Due to the worse cardiovascular prognosis associated with subclinical cardiac damage, subjects with MH should be carefully screened in order to detect hypertensive organ damage and provide appropriate therapeutic interventions.

Ambulatory blood pressure monitoring in the elderly: features and perspectives

Aging leads to a multitude of changes in the cardiovascular system that include a rise in blood pressure. Age-related changes in blood pressure are mainly attributable to an increase in systolic blood pressure, generally associated with a slight decrease diastolic blood pressure. This leads to a widening in pulse pressure. Ambulatory blood pressure monitoring is a useful tool to understand these processes and to refine cardiovascular risk assessment. In the light of emerging data in this area, we reviewed the main features of ambulatory blood pressure in elderly and discussed the evidence showing that ambulatory blood pressure is superior to clinic blood pressure to reflect the true pattern of blood pressure over time. Furthermore, we discussed the role of weight control obtained by fitness programs to prevent an excessive rise in blood pressure with age. A thorough understanding of these concepts is of paramount importance and has therapeutic implications in the growing population of elderly subjects with increased blood pressure.

Epidemiology of masked and white-coat hypertension: the family-based SKIPOGH study

Objective

We investigated factors associated with masked and white-coat hypertension in a Swiss population-based sample.

Methods

The Swiss Kidney Project on Genes in Hypertension is a family-based cross-sectional study. Office and 24-hour ambulatory blood pressure were measured using validated devices. Masked hypertension was defined as office blood pressure<140/90 mmHg and daytime ambulatory blood pressure≥135/85 mmHg. White-coat hypertension was defined as office blood pressure≥140/90 mmHg and daytime ambulatory blood pressure<135/85 mmHg. Mixed-effect logistic regression was used to examine the relationship of masked and white-coat hypertension with associated factors, while taking familial correlations into account. High-normal office blood pressure was defined as systolic/diastolic blood pressure within the 130–139/85–89 mmHg range.

Results

Among the 652 participants included in this analysis, 51% were female. Mean age (±SD) was 48 (±18) years. The proportion of participants with masked and white coat hypertension was respectively 15.8% and 2.6%. Masked hypertension was associated with age (odds ratio (OR) = 1.02, p = 0.012), high-normal office blood pressure (OR = 6.68, p<0.001), and obesity (OR = 3.63, p = 0.001). White-coat hypertension was significantly associated with age (OR = 1.07, p<0.001) but not with education, family history of hypertension, or physical activity.

Conclusions

Our findings suggest that physicians should consider ambulatory blood pressure monitoring for older individuals with high-normal office blood pressure and/or who are obese.

Hypertension in the elderly: unique challenges and management

Elderly individuals, worldwide, are on the rise, posing new challenges to care providers. Hypertension is highly prevalent in elderly individuals, and multiple challenges face care providers while managing it. In addition to treating hypertension, the physician must treat other modifiable cardiovascular risk factors in patients with or without diabetes mellitus or chronic kidney disease to reduce cardiovascular events and mortality. This review discusses some of the unique characteristics of high blood pressure in the elderly and provides an overview of the challenges facing care providers, as well as the current recommendations for management of hypertension in the elderly.

Prevalence of hypertension among elderly persons in urban Brazil: a systematic review with meta-analysis

BACKGROUND

The prevalence of hypertension among elderly persons has been assessed in several circumscribed studies scattered across Brazil, and no representative data about this exist for the whole country. In this meta-analysis with a systematic review of the literature, we provide a summary estimate of hypertension among elderly persons in Brazil and present the trend in prevalence of the condition from 1980 to 2010.

METHODS

Population-based prevalence studies carried out between 1980 and 2010 were identified by two independent reviewers, without language restrictions, in electronic databases. For PubMed searches we used the following Mesh Terms: "Aged"[Majr] AND "Hypertension" AND "Prevalence" AND "Brazil." Elderly individuals were defined as being ≥ 60 or ≥ 65 years of age, depending on the cutoff age of the relevant study. Hypertension was defined as the use of antihypertensive medication or as a seated blood pressure ≥ 140/90mm Hg, in accord with the criteria of the Joint National Committee (JNC) on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure of the U.S. National Heart, Lung and Blood Institute. The prevalence of self-reported hypertension, assessed by household surveys and through telephone inquiries, was also evaluated. Prevalence estimates were calculated with a random-effects model.

RESULTS

On the basis of the screening process, we selected 16 studies for meta-analysis, comprising 13,978 individuals. The prevalence of hypertension for the period from 1980 to 2010, according to the JNC criteria, was 68.0% (95% CI, 65.1%-69.4%). In the 2000s, the prevalence of hypertension according to the same criteria was 68.9% (95% CI, 64.1%-73.3%), whereas the self-reported prevalence based on household surveys was 49.0% (95% CI, 46.8%-51.2%) and the prevalence based on telephone surveys was 53.8% (95% CI, 44.8%-62.6%).

CONCLUSIONS

The prevalence of hypertension is high among elderly persons in Brazil, and there is considerable underestimation of the prevalence of the disease through self-reported estimates.

Blood pressure variability in elderly persons with white-coat and masked hypertension compared to those with normotension and sustained hypertension

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSIONS

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.

Feasibility of home blood pressure measurement in elderly individuals: cross-sectional analysis of a population-based sample

BACKGROUND

Home blood pressure measurement (HBPM) is recommended by hypertension guidelines, particularly in the elderly. However, feasibility of HBPM in this age group has not been fully established. Our objective was therefore to assess HBPM feasibility in elderly individuals of the general population.

METHODS

After minimal training, 1,814 individuals aged ≥ 73 years were asked to measure their blood pressure (BP) at home six times per day (three in the morning and three in the evening) during 3 days, with the validated device OMRON M6 (exam 1). Measures of BP were self-reported by the participants on a booklet. The same procedure was applied 1-year later (exam 2). HBPM was considered as successful when at least 12 measures of the 18 were performed. Participants were also asked to complete a questionnaire intended to assess difficulties met performing HBPM.

RESULTS

Rate of success for HBPM was 96% at exam 1 and 97% at exam 2. We analyzed pattern of individuals who failed HBPM examination and found that age >80, low education level, and non-autonomy were independently associated with an increased risk of HBPM failure. HBPM was considered nonrestrictive by 89% of participants and 97% declared that HBPM was simple to perform.

CONCLUSIONS

In this population-based sample of elderly, rate of success of HBPM was high and maintained at 1-year after minimal training. Moreover, HBPM acceptance was excellent. These results suggest that HBPM is feasible and can be largely diffused to the elderly of general population. However, particular care must be given to very old, nonautonomous, and low educated individuals.

High sodium intake is associated with masked hypertension in Japanese patients with type 2 diabetes and treated hypertension

BACKGROUND

Knowledge regarding the association between dietary sodium intake and the incidence of masked hypertension is limited.

METHODS

A total of 193 Japanese type 2 diabetic outpatients who had been treated with antihypertensive agents and with office blood pressures <140/90 mm Hg were recruited. Masked hypertension was defined as having office blood pressure <140/90 mm Hg and 24-h mean ambulatory blood pressure ≥130/80 mm Hg. The dietary sodium intake was estimated by measuring the 24-h urinary sodium excretion.

RESULTS

Masked hypertension was found in 128 (66.3%) patients. An age- and sex-adjusted univariate logistic regression analysis showed that urinary albumin excretion, renin-angiotensin system inhibitor use, office systolic blood pressure, and amount of dietary sodium intake were significantly associated with masked hypertension. A multivariate logistic regression analysis also identified an older age, renin-angiotensin system inhibitor use, an office elevated systolic blood pressure, and high dietary sodium intake to be independently associated with masked hypertension. When compared with those who consumed a low salt diet (sodium <120 mEq/day), the odds ratio for the risk of exhibiting masked hypertension in patients who consumed a medium salt diet (sodium 120 to <200 mEq/day) or a high salt diet (sodium ≥200 mEq/day) were 5.3 (P < 0.001) and 12.6 (P < 0.001), respectively.

CONCLUSIONS

Masked hypertension is a common feature in type 2 diabetic patients being treated for hypertension. The observed association with sodium intake raised the hypothesis that excessive sodium intake may play a part in the genesis of masked hypertension in these patients.

Association of frailty syndrome in the elderly with higher blood pressure and other cardiovascular risk factors

BACKGROUND

Few studies have evaluated blood pressure (BP) and cardiovascular risk in older persons with frailty syndrome. The objective of the present study was to assess the cardiovascular risk factors of subjects with frailty syndrome with emphasis on BP, as compared with individuals without frailty or with prefrailty.

METHODS

This was a cross-sectional study in which 77 frail, prefrail, and nonfrail older subjects were selected according to the criteria of Fried et al.: self-reported weight loss, low grip strength, low energy, slow gait speed, and low physical activity. Anthropometric and BP measurements were obtained in the office, and home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) were also performed. Fasting glucose and plasma lipids were collected. Data were analyzed by linear fixed effects model and ANOVA.

RESULTS

Mean age was 74.5 ± 7.5 years. There was no difference in office BP or HBPM between groups, but ABPM of frail group demonstrated higher systolic and diastolic BP values over the 24 h (135/74 mm Hg, P = 0.02 and P = 0.04) and during sleep (135/74 mm Hg, P = 0.01 and P = 0.02) than nonfrail group (122/68 mm Hg and 120/67 mm Hg, respectively). Body mass index and fasting glucose were similar among groups, although abdominal circumference was greater (P = 0.04) and high-density lipoproteins (HDL) were lower (P = 0.03) in the frail group than nonfrail one (P = 0.04).

CONCLUSIONS

Subjects with frailty syndrome had higher BP evaluated by ABPM and other cardiovascular risk factors such as lower HDL and more abdominal fat than nonfrailty group.

Masked hypertension and prehypertension: diagnostic overlap and interrelationships with left ventricular mass: the Masked Hypertension Study

BACKGROUND

Masked hypertension (MHT) and prehypertension (PHT) are both associated with an increase in cardiovascular disease (CVD) risk, relative to sustained normotension. This study examined the diagnostic overlap between MHT and PHT, and their interrelationships with left ventricular (LV) mass index (LVMI), a marker of cardiovascular end-organ damage.

METHODS

A research nurse performed three manual clinic blood pressure (CBP) measurements on three occasions over a 3-week period (total of nine readings, which were averaged) in 813 participants without treated hypertension from the Masked Hypertension Study, an ongoing worksite-based, population study. Twenty-four-hour ambulatory blood pressure (ABP) was assessed by using a SpaceLabs 90207 monitor. LVMI was determined by echocardiography in 784 (96.4%) participants.

RESULTS

Of the 813 participants, 769 (94.6%) had normal CBP levels (<140/90 mm Hg). One hundred and seventeen (15.2%) participants with normal CBP had MHT (normal CBP and mean awake ABP ≥135/85 mm Hg) and 287 (37.3%) had PHT (mean CBP 120-139/80-89 mm Hg). 83.8% of MHT participants had PHT and 34.1% of PHT participants had MHT. MHT was infrequent (3.9%) when CBP was optimal (<120/80 mm Hg). After adjusting for age, gender, body mass index (BMI), race/ethnicity, history of high cholesterol, history of diabetes, current smoking, family history of hypertension, and physical activity, compared with optimal CBP with MHT participants, LVMI was significantly greater in PHT without MHT participants and in PHT with MHT participants.

CONCLUSIONS

In this community sample, there was substantial diagnostic overlap between MHT and PHT. The diagnosis of MHT using an ABP monitor may not be warranted for individuals with optimal CBP.

Hypertension in the elderly

The elderly are the most rapidly growing population group in the world. Data collected over a 30-year period have demonstrated the increasing prevalence of hypertension with age. The risk of coronary artery disease, stroke, congestive heart disease, chronic kidney insufficiency and dementia is also increased in this subgroup of hypertensives. Hypertension in the elderly patients represents a management dilemma to cardiovascular specialists and other practioners. During the last years and before the findings of the Systolic Hypertension in Europe Trial were published, the general medical opinion considered not to decrease blood pressure values similarly to other younger patients, in order to avoid possible ischemic events and poor oxygenation of the organs (brain, heart, kidney). The aim of this review article is to highlight the importance of treating hypertension in aged population in order to improve their quality of life and lower the incidence of the cardiovascular complications.