Trends In Hypertension Phenotypes Over The Lifespan

Background: White coat effects are thought to be more prevalent among older adults, while masked effects are thought to be more prevalent among younger adults. However, there are limited data examining these trends across the lifespan. Objective: To characterize trends in 24-hour ambulatory blood pressure monitoring (ABPM) measures and discordant HTN phenotypes across age groups. Methods: We extracted data from ABPMs conducted at a Boston academic medical center between 2019 and 2023. Data were examined in 20-yr age groups: <40, 40-59, 60-79, and ≥80 years. We determined the mean systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and pulse pressure (PP) by age group. Office BP (OBP) and ABPM were used to derive the following HTN phenotypes: no HTN (OBP & ABPM <140/<90 mm Hg), white coat HTN (OBP ≥140/≥90 & ABPM <140/<90 mm Hg), masked HTN (OBP <140/<90 mm Hg & ABPM ≥140/≥90 mm Hg), and sustained HTN (both ≥140/≥90 mm Hg). Trends in BP measures and phenotypes were determined via linear or logistic regression adjusted for sex, race, and ethnicity. Results: Of 628 patients with ABPM, average age was 61.1±16.5 (62% female, 22% Black, and 8% Hispanic). Across age categories, SBP increased by 2.30 (95% CI: 1.0, 3.6) mm Hg, DBP decreased by 5.4 (-6.2,-4.5) mm Hg, HR decreased by 4.4 (-5.3,-3.5) bpm, and PP increased by 7.7 (6.5, 8.8) mm Hg (all P -trends across categories <0.001). In contrast, we did not observe significant trends in HTN phenotypes across age categories ( P -trends >0.05) ( Table ). Conclusions: Age was associated with higher SBP and lower DBP, but not discordant HTN phenotypes. These findings are relevant for the interpretation of out-of-office BP measurements.