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Physiological, psychological, and behavioral factors and white coat hypertension
W C Siegel1, J A Blumenthal, G W Divine
1Department of Medicine, Duke University Medical Center, Durham, N.C. 27710.
Insights
Patients with white coat hypertension, elevated blood pressure only in clinical settings, show no increased blood pressure reactivity to stress compared to persistent hypertension. This suggests a potentially lower risk for white coat hypertension patients.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Psychology
Background:
- White coat hypertension (WCH) is defined as elevated blood pressure in clinical settings but normal readings during daily activities.
- Persistent hypertension involves elevated blood pressure in both clinical and ambulatory settings.
- WCH patients may have a lower risk of cardiovascular events compared to persistent hypertension patients.
Purpose of the Study:
- To investigate if WCH is linked to heightened blood pressure reactivity to stress.
- To compare blood pressure and psychological responses to exercise and mental stress in WCH versus persistent hypertension.
- To determine if WCH is associated with increased emotional reactivity, anger, anxiety, or depression.
Main Methods:
- Ambulatory blood pressure monitoring was used to classify 89 patients (29-59 years) with essential hypertension.
- Patients underwent treadmill exercise testing, mental stress tests (arithmetic, public speaking, video games), and psychological assessments.
- WCH defined as ambulatory SBP ≤135/DBP ≤85 mmHg; persistent hypertension as SBP ≥140/DBP ≥90 mmHg.
Main Results:
- No significant differences were found in demographic, clinical, fitness, or psychological characteristics between WCH and persistent hypertension groups.
- Blood pressure responses to exercise and mental stress did not differ significantly between the two groups.
- WCH patients exhibited lower clinic and exercise systolic blood pressures and greater variability in clinic diastolic blood pressure.
Conclusions:
- The study did not support the hypothesis that WCH is caused by greater blood pressure reactivity to stress.
- WCH patients did not show increased reactivity to exercise or mental stress compared to persistent hypertensives.
- Findings suggest WCH may not be associated with the heightened stress response previously theorized.
Abstract:
Patients with hypertension in the clinic but not during daily activities ("white coat" hypertension) may be at lower risk of hypertensive morbidity and mortality than patients with hypertension in both settings ("persistent" hypertension). We hypothesized that the white coat phenomenon was due to greater blood pressure reactivity to the stress of a clinic visit and that, as a consequence, white coat hypertensive patients would display greater blood pressure reactivity to exercise and mental stress, as well as increased emotional reactivity and higher levels of anger, anxiety, or depression. We studied 89 patients with essential hypertension between 29 and 59 years old with ambulatory blood pressure monitoring, treadmill exercise testing with oxygen consumption measurement, mental stress testing (including mental arithmetic, public speaking, and video game tasks), and psychological testing (State-Trait Anxiety Scale, Cook-Medley Hostility Scale, Center for Epidemiologic Studies Depression Scale, emotional reactivity scale). We defined white coat hypertension as a mean ambulatory systolic blood pressure of 135 mm Hg or less and diastolic 85 mm Hg or less and persistent hypertension as a mean ambulatory systolic blood pressure of 140 mm Hg or more or diastolic 90 mm Hg or more. Forty-nine patients were classified as persistent hypertensives and 20 as white coat hypertensives. No significant differences were seen in demographic or clinical characteristics, fitness level, blood pressure response to exercise or mental stress, or psychological characteristics, except that white coat hypertensive patients had lower systolic blood pressures in the clinic and during exercise and greater variability of clinic diastolic blood pressures.(ABSTRACT TRUNCATED AT 250 WORDS)