You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

822 NO EVIDENCE OF WHITE COAT EFFECT FOR SYSTOLIC BLOOD PRESSURE VARIABILITY AND ITS EFFECT ON CARDIO-VASCULAR OUTCOMES IN ELDERLY HYPERTENSIVE PATIENTS: FINDINGS FROM SECOND AUSTRALIAN NATIONAL BLOOD PRESSURE (ANBP2) STUDY.

Chowdhury, Enayet K.; Owen, Alice; Krum, Henry; Wing, Lindon M.H.; Ryan, Philip; Nelson, Mark R.; Reid, Christopher M.; on behalf of the Second Australian National Blood Pressure Study Management Committee
Journal of Hypertension:
doi: 10.1097/01.hjh.0000420433.51684.08
POSTER SESSION P3: AGEING: PDF Only
Abstract

Background: Differences in blood pressure (BP) recorded by either doctors or nurses (white coat effect) may be an important factor in the association between BP variability and clinical outcomes. Visit-to-visit Systolic BP (SBP) variability has been shown to be a strong predictor of cardiovascular events. The aim of the current analysis is to determine whether the association between visit-to-visit SBP variability and cardiovascular events is similar for BP measured by doctors in comparison to nurse measurements.

Methods: Data from 49844 visits of 5953 patients aged >65 years from ANBP2 were used. Visit-to-visit SBP variability was defined as within-individual standard deviations in SBP across visits and categorized into higher (top quartile) and lower (lower three quartiles) variability. Cox-proportional hazard models were used to explore the relationship between cardiovascular events and SBP variability.

Results: Visit-to-visit SBP variability was a strong predictor for cardiovascular events. The hazard ratio (95% confidence interval) for any first cardiovascular event with SBP variability was 1.64 (1.39 - 1.92), for stroke 2.21 (1.60-3.06), for myocardial infarction 1.85 (1.24-2.75) and for heart failure 2.36 (1.65-3.38) after adjusting for sex, age, treatment allocation and SBP at randomization. The association remained comparable when BP was measured either by doctors or clinic nurses.

Conclusions: There is no evidence of a white coat effect for SBP variability assessment which remains a strong predictor of cardiovascular outcomes in elderly treated hypertensives. Reducing visit-to-visit SBP variability might be an additional target for cardiovascular risk reduction in elderly patients additional to management of elevated absolute BP levels.

(C) 2012 Lippincott Williams & Wilkins, Inc.