WHITE-COAT HYPERTENSION AND CARDIAC ORGAN DAMAGE IN ELDERLY SUBJECTS

Purpose: The aim of this study was comparing the cardiac mass in elder ly normotensive subjects and elderly white-coat hypertensive patients by examining in perspective, in consecutive patients, office blood pre ssure (BP), ambulatory BP, and echocardiographically determined left v entricular mass. Patients and methods: We studied 42 elderly patients attending a hypertension unit: of these, 22 (mean age 68.7 +/- 3.2 yea rs) had persistent >90 mm Hg office diastolic blood pressure (DBP), >1 40 mm Hg systolic blood pressure (SEP) and <142/90 mm Hg daytime ambul atory 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 day time ambulatory BP (normotensives). White coat-patients (n=22) were se lected from a series of 75 consecutive newly diagnosed and never treat ed patients with mild hypertension (casual DBP constantly between 90 m m 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 ventricula r 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 f ind a relevant difference between left atrial diameters in the above c onsidered 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 thicknes s. Multiple regression analysis revealed that it is ambulatory, not of fice BP that carries independent information about relative wall thick ness and left ventricular mass indices.Conclusions: Since elderly whit e-coat hypertensive subjects did not display a greater cardiac involve ment than age-matched normotensives, they should be treated as such.