Background-Little is known about isolated ambulatory hypertension, a state with elevated ambulatory but normal office blood pressure (BP). This study aimed to investigate the prognostic significance of isolated ambulatory hypertension for cardiovascular morbidity in a population of elderly men. Methods and Results-At baseline, 24-hour ambulatory BP and metabolic and cardiac risk profiles were evaluated in 578 untreated 70-year-old men, participants of a population-based cohort. Subjects with isolated ambulatory hypertension (office BP Ͻ140/90 and daytime BP Ն135/85) and sustained hypertension (office BP Ն140/90 and daytime BP Ն135/85) had increased plasma glucose, body mass index, and echocardiographically determined left ventricular relative wall thickness compared with normotensive subjects (office BP Ͻ140/90 and daytime BP Ͻ135/85). Seventy-two cardiovascular morbid events (2.37 per 100 person-years at risk) occurred over 8.

Ambulatory PP was a powerful predictor of CV morbidity in elderly men, independently of office PP and other established cardiovascular risk factors. Moreover, variability of daytime SBP added important prognostic information, suggesting that 24-h ambulatory BP monitoring may contribute to an improved risk assessment in elderly subjects.

Background-The clinical significance of white-coat hypertension is still unclear. Moreover, no study has examined metabolic predictors of white-coat versus sustained hypertension. Methods and Results-We investigated men (nϭ602) in a longitudinal population-based cohort who at age 70 years were identified as normotensive, white-coat hypertensive (office blood pressure [BP] Ն140/90 and daytime ambulatory BP Ͻ135/85 mm Hg), and sustained hypertensive (office BP Ն140/90 and daytime ambulatory BP Ն135/85 mm Hg). At baseline, when the subjects were aged 50 years, blood glucose, insulin, lipids, and fatty acid composition of the serum cholesterol esters were analyzed. The investigations at age 70 years included determination of insulin sensitivity and target organ damage. At age 50 years, individuals who 20 years later were identified as white-coat hypertensive or sustained hypertensive showed significantly elevated BP, heart rate, and impaired glucose tolerance compared with normotensive subjects but white coat hypertensive subjects were leaner and had a more favorable serum cholesterol ester fatty acid profile than did sustained hypertensive subjects. At age 70 years, both white-coat and sustained hypertensive subjects showed an impaired insulin sensitivity, elevated blood glucose, and increased serum insulin and heart rate compared with normotensive subjects, but left ventricular mass and urinary albumin excretion were increased only in sustained hypertensive subjects. Conclusions-These findings indicate that although metabolic abnormalities and elevated heart rate were consistent over time in both hypertensive groups, a lower body mass index and more favorable dietary fat composition predicted the development of white-coat as opposed to sustained hypertension over 20 years. (Circulation. 2002;106:63-68.)

In this population study, an interaction between diabetes and nondipping was demonstrated regarding fasting plasma glucose, lipid levels and left ventricular mass, indicating that nondipping is a marker of risk in diabetic subjects. However, in the nondiabetic majority of the population, nondipping was not associated with either metabolic disturbances or target organ damage.

Our results provide a basis for 24 h ambulatory blood pressure reference values in elderly men. The study confirms previous findings of a high prevalence of hypertension at older age. It also indicates that blood pressure is inadequately controlled in elderly treated hypertensives.