Prevalence and predictors of white-coat response in patients with treated hypertension.

BACKGROUND: White-coat response, defined as higher office blood pressure readings than ambulatory readings, is common. Few studies have estimated its prevalence among subjects with treated hypertension, and almost none have defined its determinants. The objective of this study was to estimate the prevalence of white-coat response among subjects with treated hypertension and to determine whether the phenomenon could be predicted using clinical and psychometric data. METHODS: A total of 103 treated patients (55 men and 48 women) with uncontrolled hypertension who attended a hypertension outpatient clinic in Saskatoon between September 1993 and December 1995 were entered into the study. Patients had at least 2 clinic blood pressure readings of 140/90 mm Hg or higher, had no target organ damage or left ventricular hypertrophy, and had been prescribed 2 or more classes of antihypertensive drugs. Patients had blood pressure measured in the supine position in the clinic, were placed on 24-hour ambulatory blood pressure monitoring and then completed questionnaires before returning to the clinic. Patients were classified as exhibiting a white-coat response if their mean daytime ambulatory systolic/diastolic blood pressure was 139/89 mm Hg (both) or less, or if the systolic/diastolic pressure was at least 20/15 mm Hg (both) lower than the clinic reading. RESULTS: Eleven men (20%, 95% confidence interval [CI] 10%-33%) and 26 women (54%, 95% CI 39%-69%) showed white-coat response. Logistic regression modelling showed that determinants such as stress had significantly different effects among men and women. Separate models were therefore created for men and women. For women, perceived level of stress was the most important predictor of white-coat response (odds ratio [OR] per unit 7.0, 95% CI 1.3-36.0), followed by time since diagnosis. For men, depression was a weak predictor, with higher depression scores predicting sustained hypertension (OR per unit 1.2, 95% CI 1.01-1.5). INTERPRETATION: Sex is an important factor in white-coat response. Attempts to predict white-coat response from psychometric variables should take sex differences into account. Clinical variables were not effective as predictors of white-coat response.

Risk factor reduction behaviours in coronary angioplasty and myocardial infarction patients.

A recent study asked percutaneous transluminal coronary angioplasty (PTCA) patients in Saskatchewan (n = 210) to identify specific information surrounding their rehabilitation behaviours and motivation to change lifestyle. The scale used to elicit this information was developed and previously used to determine patient risk factor knowledge and lifestyle change behaviours among myocardial infarction (MI) patients during rehabilitation phases. The purpose of this article is to discuss the results of PTCA patients' responses and compare these findings to previously obtained data from MI patients. Risk factors most frequently reported by both PTCA and MI patients as causative factors of their heart problems included diet, job stress, low levels of exercise, and other patient-perceived factors. When asked about lifestyle restrictions post-hospitalization, PTCA patients reported more lifestyle restrictions in activities of daily living (recreation, job, social life, sexual activity and driving) following hospitalization than MI patients. Both groups of patients reported high levels of dietary changes made post-hospitalization but findings reflected that MI patients had initiated more modifiable risk factor changes overall than PTCA patients. Comparative results showed that MI patients were more likely to initiate risk factor reduction behaviours for modifiable factors such as smoking, weight reduction, job/family stress, and exercise than PTCA patients. These findings offer insight into differences between PTCA and MI patients with respect to cardiac rehabilitation behaviours and may suggest the need for different teaching-learning approaches and/or more focused patient education for PTCA patients. A goal of cardiac rehabilitation is to encourage patient initiation and maintenance of lifestyle modification behaviours based on identified risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship of health-promoting behaviour to health locus of control: analysis of one baccalaureate nursing class.

This study established a health-promoting lifestyle profile in one first year baccalaureate nursing class using the Health-Promoting Lifestyle Profile (HPLP) scale (Walker, Sechrist, & Pender, 1987). Students also completed the Multidimensional Health Locus of Control Scale. Pearson correlation coefficients were run to determine the relationship between perceived health locus of control and each of the categories in the HPLP scale. The only significant, albeit low, correlations were between: stress management and internal health locus of control (r = .39, p = .01); and, interpersonal support and powerful others locus of control (r = .33, p = .03). Although low statistical power (n = 34) may have contributed to these findings, the value of health locus of control as an antecedent to health promoting behaviour is questioned. The students in the current study did engage in health-promoting behaviours as measured by the HPLP scale, with behaviours in the categories self-actualization and interpersonal support receiving the highest scores. As a group, the students displayed a high perceived internal locus of control. There was virtually no relationship between perceived health locus of control and the health-promoting lifestyle profile categories. However, the significant relationship between internal locus of control and the dimension, stress management, and the powerful others locus of control and the dimension, interpersonal support, may indicate that people with a differing locus of control have different coping strategies.

Effects of therapeutic touch on anxiety in the institutionalized elderly.

The purpose of this study was to determine the effects of therapeutic touch, a specific healing technique, on state anxiety in 105 institutionalized elderly. A double-blind, three-group experimental design was used. State anxiety was measured using the Spielberger State-Trait Anxiety Inventory. The anxiety level of subjects who received therapeutic touch in the form of a back rub was found to be significantly lower than the anxiety level of subjects who received a back rub without therapeutic touch. Results suggest that this noninvasive intervention has potential for enhancing the quality of life for this population.

Lifestyle profiles of hypertensives.

Healthy lifestyles and quality of life are key elements in the health of individuals and the community as a whole. This study examines the relationship of specific lifestyle behaviours to blood pressure in subjects being treated for hypertension. Data were collected over a two-year period and analysis was completed in June, 1989. Discriminant analysis identified that, of the lifestyles selected, predictors of uncontrolled hypertension were a high calcium intake, a high perceived level of stress, and a 'normal' body mass index. Profiles of lifestyle behaviours identified by discriminant analysis found to be important to various age and sex groupings of the subjects are illustrated.

Alternative health care as a control strategy.

What does it mean when a patient desires to be in control of an uncontrollable illness or an uncontrollable hospital situation? This paper explores the theme, desire for control, a theme emerging from a recent ethnographic study on the use of alternative health care in a hospital setting. While it may be argued that choosing an alternative practice may be a patient's strategy to control a perceived uncontrollable situation, there are many other ways of looking at the control issue. The data derived from the conceptual reality of the informants in this study are examined in the light of research and theories of perceived control, locus of control and illusion of control.

Predicting success in antihypertensive drug therapy: the importance of nondrug variables.

The hypothesis of this study was that specific lifestyle patterns would be predictive of, or increase the risk for, uncontrolled hypertension in drug-treated hypertensive subjects. By means of a previously validated questionnaire, alcohol consumption, smoking, exercise, calcium intake, sodium intake, caffeine intake, body weight pattern and perceived stress level were evaluated in 364 subjects who attended a hypertension clinic in a large urban teaching hospital. The subjects were divided into controlled and uncontrolled categories on the basis of a clinic blood pressure reading. The number of prescribed drugs was not different between the two groups. Stratified analysis identified a high perceived stress level, a high calcium intake, and a lower body mass index as predictive of uncontrolled hypertension. Other variables showed no significant correlation. The conclusion of the study is that traditional risk factors for hypertension may assume less importance in drug-treated hypertensive patients than in untreated hypertensive patients.