Some management problems common in hypertension of the elderly
‘White coat effect’
As mentioned above, the condition of ‘white coat hypertension’ is more common in the elderly, and is often initially mistaken for ISH (see Table 3). In anticipation of a blood pressure measurement, the patient may become aware of this condition through a feeling of anxiety and an increased consciousness of heart beat. Readings of blood pressure taken by an observer (physician or nurse) in the physician’s office are high, while those taken at home by the patient are normal. The discrepancy may become more evident when the results from automated 24-hour ambulatory blood pressure recording are compared with office readings. It has been reported that the white coat response elicited by observer-conducted office blood pressure measurements can be virtually eliminated by recording blood pressure with an automated device while the patient rests alone in a quiet room.52 ‘White coat hypertension’ is deemed usually not to require treatment. However, a recent 10-year follow-up study of subjects with this syndrome showed that they may develop sustained hypertension, and may have a worse prognosis than normotensive subjects.53