White-Coat Effect Among Older Adults: Data From the Jackson Heart Study.
Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the "white-coat effect," may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] ≥140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white-coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2-15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7-11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1-20.2 and 8.6 mm Hg, 95% CI, 5.0-12.3, respectively; P=.04). After multivariable adjustment, clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white-coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
Rikki M
RM
Tanner
Department of Medicine, Columbia University Medical Center, New York, NY.
Daichi
D
Shimbo
Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS.
Samantha R
SR
Seals
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Kristi
K
Reynolds
Department of Veterans Affairs Medical Center, Atlanta, GA.|Department of Medicine, Emory University, Atlanta, GA.
C Barrett
CB
Bowling
Department of Population Health, New York University School of Medicine, New York, NY.
Gbenga
G
Ogedegbe
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
Paul
P
Muntner
D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000523:psychology; D015897:Comorbidity; D003710:Demography; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D059466:White Coat Hypertension / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy