title: Does white coat hypertension require treatment over age 80?: Results of the hypertension in the very elderly trial ambulatory blood pressure side project.
abstract: White coat hypertension is considered to be a benign condition that does not require antihypertensive treatment. Ambulatory blood pressure (ABP) was measured in 284 participants in the Hypertension in the Very Elderly Trial (HYVET), a double-blind randomized trial of indapamide sustained release 1.5 mg±perindopril 2 to 4 mg versus matching placebo in hypertensive subjects (systolic blood pressure 160-199 mm Hg) aged >80 years. ABP recordings (Diasys Integra II) were obtained in 112 participants at baseline and 186 after an average follow-up of 13 months. At baseline, clinic blood pressure (CBP) exceeded the morning ABP by 32/10 mm Hg. Fifty percent of participants fulfilled the established criteria for white coat hypertension. The highest ABP readings were in the morning (average 140/80 mm Hg), the average night-time pressure was low at 124/72 mm Hg, and the average 24-hour blood pressure was 133/77 mm Hg. During follow-up, the systolic/diastolic blood pressure placebo-active differences averaged 6/5 mm Hg for morning ABP, 8/5 mm Hg for 24-hour ABP, and 13/5 mm Hg for CBP. The lowering of blood pressure over 24 hours supports the reduction in blood pressure with indapamide sustained release±perindopril as the explanation for the reduction in total mortality and cardiovascular events observed in the main HYVET study. Because we estimate that 50% had white coat hypertension in the main study, this condition may benefit from treatment in the very elderly.
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Bulpitt
authors.forename: Nigel
authors.initials: N
authors.lastname: Beckett
authors.forename: Ruth
authors.initials: R
authors.lastname: Peters
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
authors.forename: Ji-Guang
authors.initials: JG
authors.lastname: Wang
authors.forename: Marius
authors.initials: M
authors.lastname: Comsa
authors.forename: Robert H
authors.initials: RH
authors.lastname: Fagard
authors.forename: Dan
authors.initials: D
authors.lastname: Dumitrascu
authors.forename: Vesselka
authors.initials: V
authors.lastname: Gergova
authors.forename: Riitta L
authors.initials: RL
authors.lastname: Antikainen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cheek
authors.forename: Chakravarthi
authors.initials: C
authors.lastname: Rajkumar
mesh_terms: D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007190:Indapamide / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D020913:Perindopril / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D059466:White Coat Hypertension / Q000188:drug therapy*
chemical_list: D000959:Antihypertensive Agents; D007190:Indapamide; D020913:Perindopril