title: Uncontrolled hypertension in older patients: markers and associated factors to masked and white-coat effect.
abstract: BACKGROUND
  Hypertension is the main risk factor for cardiovascular diseases, affecting more than half the elderly population. It is essential to know if they have proper control of hypertension. The aim of this study was to identify the associated factors to masked uncontrolled hypertension and false uncontrolled hypertension in older patients.
  
  
  METHODS
  Two-hundred seventy-three individuals (70.1 ± 6.7 years-old) had blood pressure (BP) measured at the office and by ambulatory BP monitoring (ABPM), with the definition of controlled group (C), individuals with high office BP and adequate ABPM, called white-coat effect group (WCE), uncontrolled (UC), and subjects with appropriate office BP and elevated ABPM denominated masked effect group (ME). Age, body mass index, diabetes, pulse pressure (PP) and BP dipping during sleep were evaluated (Kruskal-Wallis test and logistic regression models).
  
  
  RESULTS
  Age was higher in UC than in C and ME (P< 0.01), and 24-h ABPM PP was lower in C (48 ± 7 mmHg) and WCE (51 ± 6 mmHg) than in UC (67 ± 12 mmHg) and ME (59 ± 8 mmHg) (P< 0.01). Sleep systolic BP dipping was lower in ME than in C (P= 0.03). Female gender was associated with a greater chance of being of ME group, which showed a higher PP and lower BP dipping during sleep.
  
  
  CONCLUSIONS
  In older individuals, office BP measurements did not allow the detection of associated factors that would permit to differentiate WCE from UC group and C from ME group. ABPM favored the identification of a higher PP and a lower BP dipping during sleep in the masked effect and uncontrolled groups.
authors: Division of General Internal Medicine & Geriatrics, Internal Medicine Department, Ribeirão Preto Medical School, São Paulo University, São Paulo, Brazil.
authors: Nereida Kc
authors: NK
authors: Lima
authors: Division of General Internal Medicine & Geriatrics, Internal Medicine Department, Ribeirão Preto Medical School, São Paulo University, São Paulo, Brazil.
authors: Julio C
authors: JC
authors: Moriguti
authors: Division of General Internal Medicine & Geriatrics, Internal Medicine Department, Ribeirão Preto Medical School, São Paulo University, São Paulo, Brazil.
authors: Eduardo
authors: E
authors: Ferriolli
keywords: Ambulatory blood pressure monitoring; Hypertension; Masked effect; The aged; White coat effect