Hypertension labeling and well-being: alternative explanations in cross-sectional data

We attempted to replicate recent cross-sectional findings suggesting that the process of being labeled a hypertensive may result in reductions in the perception of well-being among normotensives. From a community survey, 1849 normotensives were categorized by the presence or absence of either a provider message about hypertension (history) or the belief that they have hypertension (self-diagnosis). Normotensives with any label reported greater numbers of depressive and medical symptoms, poorer self-perceived health and more disability than those with neither label. Multiple regression analysis showed that whereas a history was significantly associated only with symptoms, a self-diagnosis was more strongly associated with measures of morbidity. In addition, there was a significant positive relationship between a hypertensive history and the number of physician visits in the previous year. Because the described associations are cross-sectional, labeling may undermine one's sense of well-being, or, individuals with greater self-perceived morbidity may visit physicians more frequently and, as a result, have a greater opportunity for a blood pressure elevation to be detected.