Abstract Body: Introduction: Overtreatment of white coat hypertension (WCH) can increase fall risk and polypharmacy, while undertreatment of masked hypertension (MH) can increase cardiovascular risk.

Hypothesis: In an older adult cohort, we hypothesized a high prevalence of discordant hypertension status (WCH and MH) determined by clinic vs. home BP monitoring (HBPM) and characterized associated risk factors.

Methods: At Visit 10 in 2023, ARIC participants had BP measured (3 readings, 1-minute apart after a 5-minute rest) in clinic using an Omron HEM907XL and HBPM (morning and evening, averaged over 8 days) using an Omron Series 10 BP7450. Following clinical guideline definitions, WCH was defined as a clinic SBP ≥140 mmHg or DBP ≥90 mmHg with HBPM SBP <135 mmHg and DBP <85 mmHg. MH was defined as a clinic SBP <140 and DBP <90 mmHg with HBPM SBP ≥135 or DBP ≥85 mmHg. We used logistic regression to examine associations of clinical factors with WCH and MH, adjusting for age, sex, and race-center. In sensitivity analyses, we restricted the sample to participants on antihypertensive medications (84%) and examined associations with a ≥2-stage difference in hypertension classification based on clinical guidelines cutoffs for HBPM vs. clinic BP.

Results: Among 927 participants (median age 83 years, 25% Black, 40% male), WCH and MH prevalences were 14% and 16%, respectively (Table). Concordance between clinic vs. HBPM derived hypertension stage was low [Cohen’s kappa = 0.22 (0.18, 0.26), Figure 1]. Use of anxiety medications [OR: 2.60 (1.35, 5.02)] and older age [OR per 5-year increment: 1.25 (1.00, 1.55)] were associated with MH (Figure 2). Though the association was not significant in the full cohort, among participants on antihypertensive treatment (n = 774), lower BMI [per 5-kg/m² increment: 0.74 (0.59, 0.93)] was also associated with WCH. In sensitivity analyses, use of anxiety, beta blocker, and diabetes medication, older age, and a past medical history of coronary heart disease were associated with having a ≥2-stage difference in hypertension status determined by HBPM vs. clinic BP.

Conclusions: A high proportion of older adults had a discordant hypertension status assessed by clinic vs. HBPM. These results highlight how using clinic vs. HBPM can lead to diagnostic differences in hypertension status and potentially medical management. Further research is needed to determine how to best use these measures to optimize hypertension management in older adults.