Key result
The blood pressure response to a doctor's visit was unrelated to the difference between clinic and daytime BP but correlated with changes caused by a public speaking test.
Why the study?
Is the white-coat effect related to the difference between clinic and daytime blood pressure or to reactivity to public speaking in young subjects?
Cross-Sectional (n=97)
Is the white-coat effect related to the difference between clinic and daytime blood pressure or to reactivity to public speaking in young subjects?
The white-coat effect is associated with an exaggerated response to psycho-social stimuli rather than the difference between clinic and daytime blood pressure, suggesting average daytime BP incorporates reactions to daily triggers.
Answers are grounded in this paper and cite their sources.
Clinic-daytime BP differences may not mark true white-coat reactivity; leaves open whether psychosocial stress testing better identifies it in young hypertensives.
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 (DeltaC-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. DeltaC-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 DeltaC-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, 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 microg/24 h, = 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, = 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 DeltaC-D does not reflect the true WCE.
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Palatini et al. (2003) conducted a cross-sectional in Stage-1 hypertension (n=97). Doctor's visit (white-coat effect) vs. Normotensive controls was evaluated on Relationship between direct and surrogate measure of white-coat effect and BP response to public speaking (p=<0.001). The blood pressure response to a doctor's visit was unrelated to the difference between clinic and daytime BP but correlated with changes caused by a public speaking test.
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