ABSTRACT
Sixty-one healthy subjects participated in a laboratory study carried out in a simulated clinical setting. Anticipatory anxiety-state was assessed at the arrival and immediately after, with no brief phase of adaptation, measurements of intraocular pressure, heart rate, systolic and diastolic blood pressure were collected. At the end of the procedure, anxiety-trait was also assessed. Results suggest that high levels of both anxiety-state and anxiety-trait significantly predicted a clinically relevant increase of intraocular pressure. Anxiety-state mediated the relationship between anxiety-trait and intraocular pressure, which also was found to be related with heart rate but not related to both systolic and diastolic blood pressure. These results suggest a common mechanism of regulation underlying anxiogenic variability found on both intraocular pressure and heart rate. A reduction in parasympathetic activity appears as a possible mechanism underlying to this phenomenon. This anxiety-enhanced intraocular pressure could be considered a phenomenon analogous to white coat hypertension found in the measurement of blood pressure; therefore, it probably should be taken into account in the clinical context to prevent errors in the diagnosis of glaucoma. Further research on cognitive and emotional regulation of intraocular pressure is needed to best characterize this hypothetical phenomenon.
Subject(s)
Anxiety/psychology , Glaucoma/diagnosis , Intraocular Pressure/physiology , White Coat Hypertension/psychology , Adult , Blood Pressure/physiology , Female , Healthy Volunteers , Heart Rate/physiology , Humans , Male , Young AdultABSTRACT
INTRODUCTION: Blood pressure (BP) elevation in medical office settings in patients who are normotensive in nonmedical settings is an effect known as 'white coat hypertension'. This phenomenon is thought to be due to situational anxiety caused by the experience of visiting a doctor and the anxiety-inducing nature of the medical office. Our study was designed to determine if carefully selected photographic art could counter the anxiety that causes white coat hypertension and lead to lower BP recordings in some patients. METHODS: 117 adults, non-pregnant patients from the Louisiana State University Health Sciences Center Family Medicine Resident Clinic participated in this study. After the triage nurse measured the BP, the patients were randomly placed in either an exam room with standard medical posters (control room) or in an exam room with photographic art (photo room). The BP was measured in the exam room. After the medical visit, the patients switched rooms and the BP was measured a third time. The patients were asked to fill out a questionnaire to identify room preference. RESULTS: On average, the BP obtained in the control rooms was higher than that obtained in the photo rooms. There was a statistically significant difference between the mean arterial pressure, systolic BP and diastolic BP between the control room and the photo room. CONCLUSIONS: Landscape photographic art may have the beneficial effect of reducing BP in medical office examination rooms.
Subject(s)
Art , Blood Pressure , Photography , White Coat Hypertension/prevention & control , White Coat Hypertension/psychology , Adult , Blood Pressure Determination , Female , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
White coat hypertension, also referred to as isolated clinical hypertension, is a condition in which blood pressure rises in the medical setting due to anxiety. White coat hypertension causes no more than 15 mmHg increase in systolic blood pressure or 7 mmHg increase in diastolic blood pressure in normotensive patients, and these increases in blood pressures should return to baseline within 3 visits to the medical provider. In this case, a 77-year-old white man presented to preoperative testing, with a blood pressure of 265/101 mmHg, claiming to have white coat hypertension. This case discusses the interventions implemented for this particular patient and the misdiagnosis and misperceptions of white coat hypertension by both clinicians and patients. This article also addresses recommendations for diagnosis, treatment options, and follow-up for patients with true white coat hypertension.
Subject(s)
Blood Pressure Determination , Evidence-Based Nursing/methods , Hypertension/etiology , White Coat Hypertension/psychology , Aged , Ambulatory Surgical Procedures/psychology , Humans , Hypertension/complications , MaleABSTRACT
The relationship between white coat hypertension (WCH) and anxiety remains not fully elucidated. This study aims to investigate the correlation between WCH and Templer's Death Anxiety Scale (T-DAS) questionnaire. Asymptomatic individuals with a familial history of sudden cardiac death or acute myocardial infarction within the last year, who presented at our cardiology outpatient clinic, were enrolled in this prospective, single-center, cross-sectional study. Among those with elevated blood pressure in the outpatient clinic setting, participants were categorized into normotensive and WCH groups through 24-hour ambulatory blood pressure monitoring. Demographic features, laboratory parameters, and T-DAS scores were documented. Logistic regression and sensitivity analyses were conducted to ascertain WCH occurrence. Among 324 consecutive participants, 90 were diagnosed with WCH. T-DAS scores were significantly elevated in the WCH subgroup, particularly among those seeking early medical attention following bereavement. Multivariable logistic regression highlighted gender, BMI, heart rate, T-DAS, and admission time as independent correlates of WCH. Significantly, T-DAS exhibited the third most substantial contribution to the regression analysis, following admission time and heart rate. The multivariable logistic regression analysis incorporating T-DAS exhibited high robustness, discrimination, fit, and calibration, with a Brier score of 0.106, adjusted R2 of 0.576, and C-statistic of 0.905 (95% CI: 0.871-0.940, p < 0.001). T-DAS, with a threshold of >8, demonstrated 48% sensitivity and 90% specificity in detecting WCH. Additionally, decision curve analysis verified that the model including T-DAS offers a net benefit in detecting WCH. This study unveils a potential association between WCH and death anxiety.
Subject(s)
Anxiety , White Coat Hypertension , Humans , Male , Female , Cross-Sectional Studies , Middle Aged , White Coat Hypertension/diagnosis , White Coat Hypertension/psychology , White Coat Hypertension/physiopathology , Anxiety/psychology , Anxiety/diagnosis , Prospective Studies , Adult , Aged , Blood Pressure Monitoring, Ambulatory , Blood PressureABSTRACT
Although the white-coat effect (WCE) is not rare, its detection is often difficult in treated hypertensive patients. The aim of this study was to elucidate the factors that affect and predict the WCE in treated hypertensive patients in Korea. A total of 1087 outpatients (mean age: 57 ± 10 y; 52% female) checked blood pressure in office and at home. We divided the outpatients into two groups according to the presence or absence of the WCE. Waist circumference was smaller in the WCE group. In addition, in the WCE group, the incidence of diabetes mellitus (DM) was lower, but family history of premature cardiovascular disease was higher. Target organ damage, including damage to the heart, was lower in the WCE group. Pulse pressure (PP) in the clinic was higher in the WCE group and was also positively correlated with a systolic WCE, especially when measured by a doctor (r = 0.511, P < .001). By multivariate regression analysis, PP measured by a doctor independently correlated with systolic WCE (ß = 0.573, P < .001). Our findings suggest that PP measured by a doctor at a clinic may predict the WCE, which can help in the treatment of hypertensive patients.
Subject(s)
Asian People/statistics & numerical data , Blood Pressure , Office Visits , Stress, Psychological , White Coat Hypertension/diagnosis , White Coat Hypertension/physiopathology , Aged , Algorithms , Blood Pressure Monitoring, Ambulatory/adverse effects , Female , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Incidence , Male , Middle Aged , Multivariate Analysis , Office Visits/statistics & numerical data , Outpatients/statistics & numerical data , Predictive Value of Tests , Republic of Korea/epidemiology , Risk Factors , Sensitivity and Specificity , Stress, Psychological/epidemiology , Stress, Psychological/physiopathology , White Coat Hypertension/epidemiology , White Coat Hypertension/psychologyABSTRACT
BACKGROUND: Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. We explored patients' perspectives of the barriers and facilitators to undergoing ABPM or HBPM. METHODS: Focus groups were conducted with twenty English- and Spanish-speaking individuals from underserved communities in New York City. Two researchers analyzed transcripts using a conventional content analysis to identify barriers and facilitators to participation in ABPM and HBPM. RESULTS: Participants described favorable attitudes toward testing including readily understanding white coat hypertension, agreeing with the rationale for out-of-office testing, and believing that testing would benefit patients. Regarding ABPM, participants expressed concerns over the representativeness of the day the test was performed and the intrusiveness of the frequent readings. Regarding HBPM, participants expressed concerns over the validity of the monitoring method and the reliability of home blood pressure devices. For both tests, participants noted that out-of-pocket costs may deter patient participation and felt that patients would require detailed information about the test itself before deciding to participate. Participants overwhelmingly believed that out-of-office testing benefits outweighed testing barriers, were confident that they could successfully complete either testing if recommended by their provider, and described the rationale for their testing preference. CONCLUSIONS: Participants identified dominant barriers and facilitators to ABPM and HBPM testing, articulated testing preferences, and believed that they could successfully complete out-of-office testing if recommended by their provider.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure , Health Knowledge, Attitudes, Practice , Hypertension/diagnosis , Patient Acceptance of Health Care , Aged , Blood Pressure Monitoring, Ambulatory/economics , Female , Health Care Costs , Health Expenditures , Humans , Hypertension/economics , Hypertension/physiopathology , Hypertension/psychology , Male , Middle Aged , New York City , Patient Preference , Predictive Value of Tests , Qualitative Research , Reproducibility of Results , White Coat Hypertension/diagnosis , White Coat Hypertension/physiopathology , White Coat Hypertension/psychologyABSTRACT
Refractory hypertension is a recently described phenotype of antihypertensive treatment failure defined as uncontrolled blood pressure (BP) despite the use of ≥5 different antihypertensive agents, including chlorthalidone and spironolactone. Recent studies indicate that refractory hypertension is uncommon, with a prevalence of ≈5% to 10% of patients referred to a hypertension specialty clinic for uncontrolled hypertension. The prevalence of white-coat effect, that is, uncontrolled automated office BP ≥135/85 mm Hg and controlled out-of-office BP <135/85 mm Hg, by awake ambulatory BP monitor in hypertensive patients overall is ≈30% to 40%. The prevalence of white-coat effect among patients with refractory hypertension has not been previously reported. In this prospective evaluation, consecutive patients referred to the University of Alabama at Birmingham Hypertension Clinic for uncontrolled hypertension were enrolled. Refractory hypertension was defined as uncontrolled automated office BP ≥135/85 mm Hg with the use of ≥5 antihypertensive agents, including chlorthalidone and spironolactone. Automated office BP measurements were based on 6 serial readings, done automatically with the use of a BpTRU device unobserved in the clinic. Out-of-office BP measurements were done by 24-hour ambulatory BP monitor. Thirty-four patients were diagnosed with refractory hypertension, of whom 31 had adequate ambulatory BP monitor readings. White-coat effect was present in only 2 patients, or 6.5% of the 31 patients with refractory hypertension, suggesting that white-coat effect is largely absent in patients with refractory hypertension. These findings suggest that white-coat effect is not a common cause of apparent lack of BP control in patients failing maximal antihypertensive treatment.
Subject(s)
Chlorthalidone/therapeutic use , Hypertension , Spironolactone/therapeutic use , White Coat Hypertension , Adult , Antihypertensive Agents/therapeutic use , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Drug Resistance , Female , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathology , Hypertension/psychology , Male , Middle Aged , Prevalence , Prospective Studies , United States/epidemiology , White Coat Hypertension/diagnosis , White Coat Hypertension/epidemiology , White Coat Hypertension/physiopathology , White Coat Hypertension/psychologyABSTRACT
This study was to evaluate the role of hospital environment or physician presence for white coat effect (WCE) in hypertensive patients. At first, 54 hypertensive outpatients diagnosed on office blood pressure (OBP) were included for 2-week placebo run in. During the second week of the run in period, home BP was measured using electronic BP monitors for 5-7 days. Finally, 26 sustained hypertensive patients with home systolic BP/diastolic BP over 135/85 (but <180/110) mm Hg were enrolled for 8-week treatment of nifedipine controlled-release tablet. In the visit day, BP was measured by patient-self (OBP-p) or by doctor (OBP-d) according to order determined with randomization method. The self-BP measurement was performed in a reception room of hospital. The differences between home BP and OBP-d or OBP-p were calculated as WCE calculated on doctor-measurement (WCE-d) or WCE calculated on patient-measurement (WCE-p), respectively. The home and OBP were measured with the same BP device for each patient during the study period. In the total 54 outpatients received placebo, the WCE-d was similar to the WCE-p (for systolic BP 6.6 ± 14.4 vs. 6.8 ± 15.8 mm Hg, NS; for diastolic BP 3.3 ± 8.8 vs. 2.9 ± 9.2 mm Hg, NS). Meanwhile, the 26 sustained hypertensive patients had similar systolic WCE-d and WCE-p (4.8 ± 10.3 vs. 5.0 ± 12.2 mm Hg, NS) at placebo stage. Similarly, these values were comparable (3.0 ± 14.0 vs. 2.2 ± 14.4 mm Hg, NS) in treatment stage. Hospital environment plays a main role for the WCE in hypertensive patients.
Subject(s)
Blood Pressure Determination/psychology , Calcium Channel Blockers/therapeutic use , Health Facility Environment , Nifedipine/therapeutic use , White Coat Hypertension/drug therapy , White Coat Hypertension/psychology , Adult , Aged , Blood Pressure/drug effects , Blood Pressure/physiology , Blood Pressure Determination/methods , Delayed-Action Preparations/therapeutic use , Female , Hospitals , Humans , Male , Middle Aged , Outpatients/psychology , Placebos , Young AdultABSTRACT
BACKGROUND: Blood pressure (BP) self-screening, whereby members of the public have access to BP monitoring equipment outside of healthcare consultations, may increase the detection and treatment of hypertension. Currently in the UK such opportunities are largely confined to GP waiting rooms. AIM: To investigate the reasons why people do or do not use BP self-screening facilities. DESIGN AND SETTING: A cross-sectional, qualitative study in Oxfordshire, UK. METHOD: Semi-structured interviews with members of the general public recruited using posters in GP surgeries and community locations were recorded, transcribed, and coded thematically. RESULTS: Of the 30 interviewees, 20% were hypertensive and almost half had self-screened. Those with no history of elevated readings had limited concern over their BP: self-screening filled the time waiting for their appointment or was done to help their doctor. Patients with hypertension self-screened to avoid the feelings they associated with 'white coat syndrome' and to introduce more control into the measurement process. Barriers to self-screening included a lack of awareness, uncertainty about technique, and worries over measuring BP in a public place. An unanticipated finding was that several interviewees preferred monitoring their BP in the waiting room than at home. CONCLUSION: BP self-screening appeared acceptable to service users. Further promotion and education could increase awareness among non-users of the need for BP screening, the existence of self-screening facilities, and its ease of use. Waiting room monitors could provide an alternative for patients with hypertension who are unwilling or unable to monitor at home.
Subject(s)
Blood Pressure Monitoring, Ambulatory/statistics & numerical data , General Practice , Hypertension/diagnosis , Patient Preference/statistics & numerical data , Self Care/statistics & numerical data , Adult , Aged , Attitude of Health Personnel , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory/psychology , Cross-Sectional Studies , Female , Health Care Surveys , Humans , Hypertension/psychology , Interviews as Topic , Male , Middle Aged , Patient Compliance/statistics & numerical data , Patient Preference/psychology , Qualitative Research , Self Care/psychology , United Kingdom , White Coat Hypertension/psychologyABSTRACT
Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the "white-coat effect," may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] ≥140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white-coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2-15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7-11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1-20.2 and 8.6 mm Hg, 95% CI, 5.0-12.3, respectively; P=.04). After multivariable adjustment, clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white-coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults.
Subject(s)
Blood Pressure Monitoring, Ambulatory , White Coat Hypertension , Adult , Black or African American/psychology , Black or African American/statistics & numerical data , Age Factors , Aged , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/psychology , Comorbidity , Demography , Disease Management , Female , Humans , Male , Middle Aged , Mississippi/epidemiology , Outcome Assessment, Health Care , Risk Factors , Socioeconomic Factors , White Coat Hypertension/diagnosis , White Coat Hypertension/ethnology , White Coat Hypertension/psychology , White Coat Hypertension/therapyABSTRACT
INTRODUCTION: Alarm reaction to clinical blood pressure (BP) measurement, defined white-coat effect (WCE), can cause overestimation of true BP values. AIM: To assess whether ambulatory blood pressure monitoring (ABPM) can similarly affect BP values during the initial hours of recording. METHODS: In 420 ABPMs selected for a first systolic BP (SBP) reading at least 10 mmHg higher than the mean daytime SBP, we calculated mean diurnal and 24 h SBP with and without the exclusion of the two first hours of recording defined as the WCE window (WCEw). We also calculated the magnitude and duration of WCE. These analyses were also performed separately in patients off anti-hypertensive treatment (n = 156), and on treatment with and without the inclusion of beta-blockers (respectively n = 113 and 151). RESULTS: Exclusion of WCEw period reduced mean diurnal and 24 h SBP respectively from 135 ± 0.5 to 133 ± 0.5 (p < 0.01) and from 131 ± 0.5 to 130 ± 0.5 (p < 0.02). As a result the percentage of patients diagnosed as having diurnal or 24 h hypertension was reduced respectively from 48 to 40 % and from 52 to 47 %. The magnitude of WCEw was similar in both genders but the duration was longer in females (66 ± 2 vs. 56 ± 2 min, p < 0.01). Treatment with beta-blockers was associated with a shorter duration of WCE in both genders but this effect was statistically significant only in males. CONCLUSIONS: In some patients ABPM is not free from WCE. WCE may affect the overall estimation of BP profile and is longer but less blunted by beta-blockers in females than in males.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Antihypertensive Agents/therapeutic use , Blood Pressure Monitoring, Ambulatory , Blood Pressure/drug effects , White Coat Hypertension/drug therapy , Circadian Rhythm , Female , Humans , Male , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Risk Factors , Sex Factors , Time Factors , Treatment Outcome , White Coat Hypertension/diagnosis , White Coat Hypertension/physiopathology , White Coat Hypertension/psychologyABSTRACT
BACKGROUND: While it is known that excessive anxiety surrounding the measuring of blood pressure may preclude an accurate measurement, it is not known whether it could also lead to phobic avoidance behavior. METHODS: Self-reported information was collected on 125 individuals who made postings on 5 internet-based medical forums. RESULTS: Qualitative thematic analysis revealed that these individuals reported experiencing intense fear associated with the measuring of blood pressure, that was excessive or irrational and which contributed to avoidance of medical treatment and interference with life decisions. CONCLUSIONS: Based on these preliminary observations, we are speculating that these symptoms could be considered consistent with a diagnosis of a Specific Phobia. Investigations using quantitative methods, representative samples, and standardized clinical instruments need to be conducted before definitive conclusions can be reached.
Subject(s)
Avoidance Learning , Blood Pressure Determination/psychology , Phobic Disorders , Data Collection , Humans , Phobic Disorders/diagnosis , Phobic Disorders/etiology , Phobic Disorders/prevention & control , Phobic Disorders/psychology , Psychological Techniques , White Coat Hypertension/diagnosis , White Coat Hypertension/prevention & control , White Coat Hypertension/psychologyABSTRACT
BACKGROUND: The magnitude of the 'white coat effect', the alerting rise in blood pressure, is greater for doctors than nurses. This could bias interpretation of studies on nurse-led care in hypertension, and risks overestimating or overtreating high blood pressure by doctors in clinical practice. AIM: To quantify differences between blood pressure measurements made by doctors and nurses. DESIGN AND SETTING: Systematic review and meta-analysis using searches of MEDLINE, CENTRAL, CINAHL, Embase, journal collections, and conference abstracts. METHOD: Studies in adults reporting mean blood pressures measured by doctors and nurses at the same visit were selected, and mean blood pressures extracted, by two reviewers. Study risk of bias was assessed using modified Cochrane criteria. Outcomes were pooled across studies using random effects meta-analysis. RESULTS: In total, 15 studies (11 hypertensive; four mixed hypertensive and normotensive populations) were included from 1899 unique citations. Compared with doctors' measurements, nurse-measured blood pressures were lower (weighted mean differences: systolic -7.0 [95% confidence interval {CI} = -4.7 to -9.2] mmHg, diastolic -3.8 [95% CI = -2.2 to -5.4] mmHg). For studies at low risk of bias, differences were lower: systolic -4.6 (95% CI = -1.9 to -7.3) mmHg; diastolic -1.7 (95% CI = -0.1 to -3.2) mmHg. White coat hypertension was diagnosed more frequently based on doctors' than on nurses' readings: relative risk 1.6 (95% CI =1.2 to 2.1). CONCLUSIONS: The white coat effect is smaller for blood pressure measurements made by nurses than by doctors. This systematic difference has implications for hypertension diagnosis and management. Caution is required in pooling data from studies using both nurse- and doctor-measured blood pressures.
Subject(s)
Blood Pressure Determination/psychology , Blood Pressure , Nurses , Physicians , White Coat Hypertension/psychology , Adult , Blood Pressure Determination/methods , Evidence-Based Medicine , Humans , Referral and Consultation , White Coat Hypertension/diagnosisABSTRACT
OBJECTIVES: Anxiety and other psychological dispositions are thought to be associated with blood pressure. This study tests whether personality traits have long-term associations with masked and white-coat effects. METHODS: A community-based sample of 2838 adults from Sardinia (Italy) completed the Revised NEO Personality Inventory, and 7 years later, blood pressure was assessed in the clinic and with ambulatory monitoring. Logistic regressions were used to test whether anxiety, neuroticism, extraversion, openness, agreeableness, and conscientiousness predicted the white-coat and masked hypertension phenomena. Age, sex, and antihypertensive medication use were tested as moderators. RESULTS: Significant interactions were found between personality traits and antihypertensive medications in predicting masked and white-coat effects. Only among those taking antihypertensive medication, higher anxiety was associated with a higher risk of pseudo-resistant hypertension due to white-coat effect (odds ratio 1.39, 95% confidence interval 1.01-1.91) and higher conscientiousness was associated with a lower risk of masked uncontrolled hypertension (odds ratio 0.70, 95% confidence interval 0.49-0.99). There were no significant interactions with age or sex. CONCLUSIONS: Among those on antihypertensive medications, anxious individuals were more likely to have pseudo-resistant hypertension due to white-coat effect and less conscientious individuals were at increased risk of masked uncontrolled hypertension. Particularly among anxious and less conscientious individuals, ambulatory monitoring may improve the tailoring of pharmacological treatments.
Subject(s)
Masked Hypertension/epidemiology , Personality , White Coat Hypertension/epidemiology , Adult , Aged , Antihypertensive Agents/therapeutic use , Blood Pressure/physiology , Blood Pressure Determination , Blood Pressure Monitoring, Ambulatory , Female , Humans , Italy/epidemiology , Logistic Models , Male , Masked Hypertension/psychology , Middle Aged , Odds Ratio , Personality Inventory , White Coat Hypertension/psychologyABSTRACT
OBJECTIVES: Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. METHODS: This study used an observational cohort design and included 220 individuals aged 35-84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. RESULTS: The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. CONCLUSION: Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice.
Subject(s)
Blood Pressure Monitoring, Ambulatory/psychology , Blood Pressure , Masked Hypertension/diagnosis , White Coat Hypertension/diagnosis , Adult , Aged , Ambulatory Care Facilities , Cohort Studies , Female , Humans , Logistic Models , Male , Masked Hypertension/psychology , Middle Aged , Sensitivity and Specificity , White Coat Hypertension/psychologyABSTRACT
OBJECTIVE: The prehypertension classification was introduced to facilitate prevention efforts among patients at increased risk for hypertension. Although patients who have been told that they have hypertension report worse outcomes than unaware hypertensives, little is known about whether or not prehypertension labeling has negative effects. We evaluated the effects of labeling individuals with prehypertension on blood pressure and health-related quality of life three months later. METHODS: One hundred adults (aged 19 to 82 [mean=40.0] years; 54% women; 64% racial/ethnic minorities) with screening blood pressure in the prehypertensive range (120-139/80-89 mmHg) and no history of diagnosis or treatment of elevated blood pressure were randomly assigned to either a "Labeled" group in which they were informed of their prehypertension, or an "Unlabeled" group in which they were not informed. Subjects underwent office blood pressure measurement, 24-hour ambulatory blood pressure monitoring and completed self-report questionnaires at baseline and at three months. RESULTS: Multilevel mixed effects regression analyses indicated that changes in the white coat effect, office blood pressure, mean daytime ambulatory blood pressure, and physical and mental health did not differ significantly between the two groups. Adjusting for age, sex, race/ethnicity and body mass index did not affect the results. CONCLUSION: These findings suggest that labeling patients with prehypertension does not have negative effects on blood pressure or quality of life. Additional research is needed to develop approaches to communicating with patients about their blood pressure that will maximize the clinical and public health impact of the prehypertension classification.
Subject(s)
Blood Pressure , Communication , Patient Education as Topic , Prehypertension/diagnosis , Prehypertension/psychology , Quality of Life/psychology , White Coat Hypertension/psychology , Adaptation, Psychological , Adult , Attitude to Health , Awareness , Female , Humans , Male , Middle Aged , White Coat Hypertension/diagnosisABSTRACT
BACKGROUND AND OBJECTIVES: Although there is some evidence that health anxiety is associated with attentional bias, relatively little research has examined the role of situational threat on bias. This study examined the effect of health threat on attentional bias for negative health words. METHODS: Participants completed questionnaires and were then randomized to receive either threatening or reassuring health-related feedback. Following randomization, participants completed the emotional Stroop and dot-probe tasks in a counter-balanced order. RESULTS: On the emotional Stroop task, all participants took longer to name the colour of negative words, as compared to positive and neutral words. However on the dot probe task, differences in attentional bias emerged based on feedback condition. Those receiving reassuring feedback displayed a bias away from negative words while those receiving threatening feedback did not display a bias either towards or away from negative words. Following reassuring feedback only, metacognitions were negatively correlated with attention towards positive health-related stimuli, suggesting another avenue for future research. CONCLUSIONS: Health threats lead to an increase in the processing of negative information, and the effect of metacognitions on processing appears to be apparent only in the absence of health threat.
Subject(s)
Attention/physiology , Attitude to Health , Anxiety/psychology , Blood Pressure/physiology , Depression/psychology , Emotions , Fear/psychology , Feedback, Psychological , Female , Heart Rate/physiology , Humans , Male , Psychiatric Status Rating Scales , Reaction Time/physiology , Stroop Test , Surveys and Questionnaires , White Coat Hypertension/psychology , Young AdultABSTRACT
BACKGROUND: The difference between clinic and ambulatory blood pressure (BP) is a poor estimate of the true white-coat effect (WCE) measured with beat-to-beat recording. METHOD: We investigated whether the difference between clinic and home BP (home WCE) was a better estimate of true WCE than ambulatory WCE. In 73 young hypertensives, ambulatory WCE was calculated as the difference between clinic BP and the mean of two 24-h BP recordings, and home WCE as the difference between clinic and home BP (HBP) measured over 6 months. All individuals underwent beat-to-beat BP monitoring with the Finometer. During the recording, a white-coat test (true WCE) and a public speaking test were performed. RESULTS: Ambulatory WCE correlated with home WCE (Pâ <â 0.001 for systolic and diastolic BPs). However, both surrogate WCEs were unrelated to true WCE (Pâ =â 0.93/0.36 and Pâ =â 0.11/0.36, respectively). True WCE correlated with the BP reaction to public speaking (Pâ <â 0.001/Pâ <â 0.001), whereas both surrogate WCEs were unrelated to the BP response to this test (all P â> â0.21). Individuals were divided into two groups according to whether BP response to the doctor's visit was above (WCH+) or below (WCH-) the median. WCH+ patients had similar clinic and ambulatory BPs to WCH- but showed a higher BP response to public speaking. CONCLUSION: As previously observed for ambulatory WCE, home WCE does not reflect the true BP reaction to doctor's visit. BP response to psychosocial stressors is increased in individuals with hyperreactivity to doctor's measurement but not in individuals with white-coat hypertension identified with either ambulatory or HBP measurement.
Subject(s)
Blood Pressure Monitoring, Ambulatory/methods , White Coat Hypertension/diagnosis , Adolescent , Adult , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Female , Humans , Male , Middle Aged , Stress, Psychological , White Coat Hypertension/physiopathology , White Coat Hypertension/psychology , Young AdultABSTRACT
OBJECTIVE: The clinical significance of masked and white-coat hypertension is still somewhat controversial. The aim of the present study was to investigate the prognosis of masked and white-coat hypertension using home blood pressure (BP) measurement. DESIGN AND METHODS: A nationwide population sample (nâ=â2046, age 44-74 years) underwent office (duplicate measurements on one visit by a nurse) and home (duplicate measurements on 7 days) BP measurements and risk factor evaluation. During the follow-up of 7.5 years, 221 fatal and nonfatal cardiovascular events and 142 all-cause deaths occurred. Masked hypertension was defined as office BP less than 140/90 mmHg with home BP at least 135/85 mmHg. RESULTS: The prevalence of baseline risk factors and the incidence of cardiovascular events and all-cause deaths increased from normotension to white-coat, masked and sustained hypertension. Unadjusted hazard ratios for white-coat hypertension were 1.18 (Pâ=â0.5) for cardiovascular events and 1.23 (Pâ=â0.5) for all-cause deaths. Masked hypertension had a significantly higher age-adjusted risk of cardiovascular events and a higher risk of all-cause mortality after adjustment for age, sex and office BP than normotension (hazard ratios 1.64, Pâ=â0.05, and 2.09, Pâ=â0.01). Masked hypertension lost its predictive significance after adjustment for home BP or concomitant other cardiovascular risk factors. CONCLUSION: Neither masked nor white-coat hypertension was an independent predictor of cardiovascular risk or all-cause mortality when concomitant other risk factors or baseline home BP levels were taken into account. The present study suggests that home BP level, along with other traditional risk factors, may be enough to stratify cardiovascular risk.