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Categories of hypertension in the elderly and their 1-year evolution. The Three-City Study

Cacciolati, Céciliaa,b; Hanon, Olivierc,d; Dufouil, Carolea,e; Alpérovitch, Annicka,b; Tzourio, Christophea,e

doi: 10.1097/HJH.0b013e32835ee0ca

Objective: To assess the 1-year risk of developing sustained hypertension in untreated elderly with white-coat hypertension (WCHT) or masked hypertension (MHT), and the 1-year risk of developing uncontrolled hypertension in treated elderly with office or home uncontrolled hypertension (OUHT or HUHT).

Methods: We studied the 1-year risk of developing sustained or uncontrolled hypertension in a community-based cohort of 1481 individuals aged at least 73 years. The same BP device was used throughout the entire study. WCHT was defined as high blood pressure (BP) at office and normal home BP without antihypertensive intake, OUHT as high office BP and normal home BP with antihypertensive intake, MHT as high BP at home and normal office BP without antihypertensive intake, and HUHT as high home BP and normal office BP with antihypertensive intake. Sustained hypertension was defined as high office and home BP without antihypertensive intake and uncontrolled hypertension as high office and home BP with antihypertensive intake.

Results: Sustained or uncontrolled hypertension at 1 year was diagnosed in 13% of participants with high office BP and in 26% of those with high home BP. Compared to participants with normal office and home BP, risk of sustained/uncontrolled hypertension was increased about three-fold in individuals with high office BP [OR = 2.9; 95% confidence interval (CI) = 1.5–5.5; P = 0.002] and about seven-fold in those with high home BP (OR = 6.8; 95% CI = 3.8–12.2; P < 0.0001). These risks were higher in individuals not treated by antihypertensive (ORWCHT = 4.3, P = 0.03; ORMHT = 16.8, P < 0.0001).

Conclusion: In this community-based study, elderly individuals with high office or home BP had an increased risk of hypertension 1 year later. This risk was higher among individuals not treated by antihypertensive and particularly in those with MHT. As these high-risk individuals would be otherwise undetected our results strongly support the large use of home blood pressure measurement in the elderly.

aINSERM, Neuroepidemiology, Bordeaux

bUPMC Univ Paris

cUniversity Paris Descartes

dDepartment of Geriatrics, Broca Hospital, Paris

eUniversity Bordeaux, Bordeaux, France

Correspondence to Professor Christophe Tzourio, Université Bordeaux Segalen, 146 rue Léo Saignat–Case 11, 33076 Bordeaux cedex, France. Tel: +33 55 757 1569; fax: +33 14 216 2541; e-mail:

Abbreviations: BP, blood pressure; HBPM, home blood pressure measurement; HUHT, home uncontrolled hypertension; MHT, masked hypertension; OUHT, office uncontrolled hypertension; WHCT, white-coat hypertension

Received 11 November, 2012

Revised 30 December, 2012

Accepted 11 January, 2013

These results were presented in part at the 21st ESH Meeting on Hypertension in Milan.

© 2013 Lippincott Williams & Wilkins, Inc.