Hypertensive subjects with a hyper-reactive blood pressure response to a doctor's visit showed significantly greater systolic reactivity to public speaking compared to normo-reactive subjects (61 vs 40 mmHg, P<0.001).
Observational (n=97)
Absolute Event Rate: 61% vs 40%
p-value: p=<0.001
Objective To compare the blood pressure (BP) response to doctor's visit with the BP reaction to a psycho-social challenge and with the difference between clinic and daytime BP (ΔC-D). Subjects We studied 64 young stage-1 hypertensive subjects and 33 normotensive controls. Main outcome measures Relationship between direct and surrogate measure of white-coat effect (WCE) and assessment of BP response to public speaking in subjects with normal or increased reaction to BP measurement. Methods The responses to BP measurement by a doctor and to public speaking were assessed with beat-to-beat Finapres recording. ΔC-D was calculated on the basis of two BP monitorings and used as a surrogate measure of WCE. Results BP and heart rate changes elicited by the visit were unrelated to ΔC-D and were correlated to the changes caused by the speech test P< 0.001 for systolic BP (SBP), P = 0.01 for diastolic BP (DBP), and P< 0.001 for heart rate. Hypertensive subjects with SBP response to doctor's visit above the median (hyper-reactive) showed increased reactivity also to public speaking (61 ± 15 mmHg), while those with BP response below the median (normo-reactive) had a response to the psycho-social challenge (40 ± 21 mmHg, P< 0.001 versus hyper-reactive) similar to that of the normotensive controls (38 ± 17 mmHg). Epinephrine urinary output was greater in the hyper-reactive than the normo-reactive subjects (23 versus 12 μg/24 h, P = 0.01). The SBP response to public speaking was greater in the hypertensive subjects with higher systolic daytime BP than in those with lower daytime BP (55.3 ± 20.9 versus 45.1 ± 20.6 mmHg, P = 0.046). Conclusions Subjects with increased WCE have an exaggerated response also to psycho-social stimuli. Average daytime BP, which incorporates the BP reactions to many psycho-social triggers can, thus, not be taken as the basal BP of an individual. This helps explain why ΔC-D does not reflect the true WCE.
Palatini et al. (Sat,) conducted a observational in Stage-1 hypertension (n=97). Hyper-reactive blood pressure response to doctor's visit vs. Normo-reactive blood pressure response was evaluated on Systolic blood pressure response to public speaking (p=<0.001). Hypertensive subjects with a hyper-reactive blood pressure response to a doctor's visit showed significantly greater systolic reactivity to public speaking compared to normo-reactive subjects (61 vs 40 mmHg, P<0.001).