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Anxiety and outcome expectations predict the white-coat effect
Juhee Jhalani1, Tanya Goyal, Lynn Clemow
1Columbia University Medical Center, 622 West 168th Street, PH-9, New York, NY 10032, USA. jj2148@columbia.edu
Blood Pressure Monitoring
|February 24, 2006
Summary
Anxiety and expectations about blood pressure readings in a doctor's office can increase the "white-coat effect," leading to higher blood pressure measurements. These psychological factors significantly influence clinical blood pressure readings.
Area of Science:
- Cardiology
- Psychology
- Hypertension Research
Background:
- The
- white-coat effect
- (WCE) is a phenomenon where clinic blood pressure (BP) is higher than ambulatory BP.
- This elevation is often attributed to anxiety or stress in a clinical setting.
- Understanding WCE's drivers is crucial for accurate hypertension diagnosis and management.
Purpose of the Study:
- To investigate the association between patient anxiety and blood pressure expectancy with the white-coat effect.
- To determine if psychological factors independently influence elevated clinic blood pressure readings.
Main Methods:
- 24-h ambulatory BP monitoring and clinic BP measurements were taken from 226 participants.
- Anxiety and expectations regarding clinic visits were assessed using validated scales.
- Multiple regression analysis was used to analyze the relationship between WCE, anxiety, and expectancy, controlling for covariates.
Main Results:
- Both anxiety and outcome expectations were significantly associated with the white-coat effect.
- Expectancy independently affected systolic WCE.
- Both anxiety and expectancy independently affected diastolic WCE.
Conclusions:
- Psychological factors, specifically anxiety and expectancy, contribute to elevated clinic blood pressure.
- These findings support the hypothesis that patient expectations and anxiety can inflate the white-coat effect.
- This highlights the importance of considering psychological states in BP measurement accuracy.