Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators

Abstract—The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (90 mm Hg) or by daytime ABP (85 mm Hg), a history of cardiovascular disease, and persons 18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP 140/90 mm Hg and ABP 135/85 mm Hg) and subjects with normal BP (CBP140/90 mm Hg and ABP135/85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95 % CI: 0.87–1.57]; P0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95 % CI: 0.79–1.53]; P0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95 % CI: 1.43–2.79]; P0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95 % CI: 1.49–2.62]; P0.0001) were at higher risk as compared with untreated normotensiv