title: Impact of Ambulatory Blood Pressure Monitoring on Control of Untreated, Undertreated, and Resistant Hypertension in Older People in Spain.
abstract: OBJECTIVE
  The impact of ambulatory blood pressure monitoring (ABPM) on hypertension control has not been fully assessed across the treatment spectrum in older community-living individuals and could have important implications; specifically, the number of untreated, undertreated, and treatment-resistant uncontrolled hypertensives in need of or with unnecessary drug treatment could vary with respect to studies based on conventional blood pressure (BP) measured in clinical settings.
  
  
  METHODS
  Cross-sectional study conducted in 2012 among 1118 community-living individuals aged ≥60 years in Spain.
  
  
  METHODS
  Three conventional BP measurements at participants' homes and 24-hour ABPM were performed under standardized conditions. Uncontrolled hypertension (mean of the last 2 conventional BP readings ≥140/90 mm Hg) was considered undertreated if on 1 or 2 antihypertensive drugs, and apparently treatment-resistant if on ≥3 drugs. White-coat effect was defined as conventional BP ≥ 140/90 mm Hg and 24-hour BP <130/80 mm Hg.
  
  
  RESULTS
  Of 720 hypertensive patients (mean age, 72.3 ± 6.3 years; 51.3%, males), 64.4% had conventional BP ≥ 140/90 mm Hg, and from these 39.9% were untreated, 49.5% undertreated, and 10.6% apparently treatment-resistant. Among uncontrolled hypertensive patients, the white-coat effect was present in 52.4% of those untreated, in 53.5% of undertreated, and in 49% of apparent treatment-resistant. These white-coat results were similar or even higher across alternative BP thresholds.
  
  
  CONCLUSIONS
  One-half of older uncontrolled hypertensive patients studied at home were actually controlled according to ABPM, regardless of treatment status. This suggests reconsideration of treatment needs in these numerous white-coat hypertensive patients, who probably do not need drug treatment initiation or intensification.
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Centro de Salud Universitario Cerro del Aire, Majadahonda, Madrid, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gijón-Conde
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Graciani
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: López-García
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Guallar-Castillón
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain. Electronic address: joseramon.banegas@uam.es.
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
mesh_terms: D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000517:prevention & control*; D057187:Independent Living; D008297:Male; D013030:Spain
keywords: Hypertension; aged; ambulatory blood pressure monitoring; control; epidemiology; treatment