White-coat hypertension and cardiac organ damage in elderly subjects

Purpose: The aim of this study was comparing the cardiac mass in elderly normotensive subjects and elderly white-coat hypertensive patients by examining in perspective, in consecutive patients, office blood pressure (BP), ambulatory BP, and echocardiographically determined left ventricular mass. Patients and methods: We studied 42 elderly patients attending a hypertension unit: of these, 22 (mean age 68.7 +/- 3.2 years) had persistent >90 mm Hg office diastolic blood pressure (DBP), >140 mm Hg systolic blood pressure (SEP) and <142/90 mm Hg daytime ambulatory BP (white-coat positives); the remaining 20 (mean age 67.4+/-2.2 years) had <90 mm Hg office DBP, <140 mm Hg SEP and <142/90 mm Hg daytime ambulatory BP (normotensives). White coat-patients (n=22) were selected from a series of 75 consecutive newly diagnosed and never treated patients with mild hypertension (casual DBP constantly between 90 mm Hg and 105 mm Hg). Results: Neither left ventricular mass index (89.9 +/- 23.1vs 91.8 +/- 25.4 P=NS and +/- 25.4 P=NS) and left ventricular mass/height, (115.4+/-17.1 vs 119.6+/-18.3 P=NS), nor relative wall thickness (0.31+/-0.44 vs 0.33+/-0.05 P=NS) were significantly higher in white-coat hypertensives as against normotensives. Neither did we find a relevant difference between left atrial diameters in the above considered groups (3.28+/-0.41 vs 3.32+/-0.37). In fact 81.8% of white-coat hypertensives had left ventricular normal geometry; whilst 13.6% only had concentric remodeling. Age and sex were associated with left ventricular mass index, left ventricular mass/height and wall thickness. Multiple regression analysis revealed that it is ambulatory, not office BP that carries independent information about relative wall thickness and left ventricular mass indices. Conclusions: Since elderly white-coat hypertensive subjects did not display a greater cardiac involvement than age-matched normotensives, they should be treated as such.