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 (Delta C-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. Delta C-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 Delta C-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 BID 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 mug/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 Delta C-D does not reflect the true WCE.
The white-coat effect is unrelated to the difference between clinic and daytime blood pressure and is associated with greater reactivity to public speaking
PALATINI, PAOLO;PALOMBA, DANIELA;SARLO, MICHELA;PESSINA, ACHILLE CESARE
2003
Abstract
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 (Delta C-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. Delta C-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 Delta C-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 BID 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 mug/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 Delta C-D does not reflect the true WCE.Pubblicazioni consigliate
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