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The role of behavioral factors in white coat and sustained hypertension
T G Pickering1, R B Devereux, W Gerin
1Cardiovascular Center, New York Hospital-Cornell Medical Center, New York 10021.
Insights
Ambulatory blood pressure monitoring distinguishes between persistent hypertension and white coat hypertension. Behavioral factors influence blood pressure profiles, with high-strain jobs linked to sustained hypertension in men.
Area of Science:
- Cardiovascular Physiology
- Behavioral Medicine
- Hypertension Research
Background:
- Ambulatory blood pressure monitoring (ABPM) differentiates between persistent hypertension and white coat hypertension.
- White coat hypertension is generally benign, potentially a conditioned response to clinical settings, without widespread physiological abnormality.
- Behavioral factors significantly impact diurnal blood pressure patterns.
Purpose of the Study:
- To explore the role of behavioral factors in persistent hypertension versus white coat hypertension.
- To investigate how occupational and domestic stress influence blood pressure diurnal profiles.
- To examine the association between job strain and sustained blood pressure elevation.
Main Methods:
- Utilized ambulatory blood pressure monitoring to assess blood pressure in different settings (clinic vs. home, work vs. non-work days).
- Compared blood pressure profiles in individuals with persistent hypertension and white coat hypertension.
- Conducted a cross-sectional study on normotensive and hypertensive men, assessing job strain.
Main Results:
- White coat hypertension is not linked to generalized physiological abnormalities and has a favorable prognosis.
- Ambulatory blood pressure varies with behavioral contexts, such as working days and varying stress levels in women.
- Men in high-strain jobs exhibited a greater likelihood of sustained blood pressure elevation.
Conclusions:
- Behavioral factors play a role in blood pressure variability and hypertension subtypes.
- White coat hypertension appears to be a distinct entity, possibly a conditioned response.
- Occupational stress, specifically high job strain, is a potential contributor to sustained hypertension.
Abstract:
Studies using ambulatory monitoring of blood pressure have indicated that patients with persistently elevated clinic pressures may be subdivided into two groups, those in whom ambulatory pressure is also elevated (persistent hypertension), and those in whom it is normal (white coat hypertension). The role of behavioral factors in contributing to these two types is discussed. Studies of white coat hypertension suggest that it is not characterized by any generalized physiological abnormality, and that target-organ damage is mild and the prognosis relatively benign. It may represent a conditioned response to the physician. Behavioral factors can significantly influence the diurnal profile of blood pressure, as shown by a comparison of ambulatory pressures recorded on working and non-working days, and in women who experience varying levels of occupational and domestic stress. The role of behavioral factors in the development of sustained hypertension (defined as an upward resetting of the diurnal profile), however, is much less clear. A cross-sectional study of normotensive and hypertensive men has shown that men employed in high-strain jobs are more likely to show a sustained elevation of blood pressure.