The Influence of Factors Such As Anxiety on the White Coat Effect During the Treatment of Patients with Hypertension

Overview

Journal Rev Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2024 Jul 30

PMID 39076195

Authors

Dengyue Xu

Hengxia Qiu

Ze Li

Peishi Yan

He Xu

Yu Gu

Hailong Lin

Affiliations

Soon will be listed here.

Abstract

Background: The white coat effect is observed in many patients with hypertension, but its mechanism is still unclear and anxiety is often thought to be a key point.

Methods: A total of 544 patients who met the inclusion criteria were recruited through outpatient clinics. Three months after systematic treatment, the office blood pressure and ambulatory blood pressure monitoring (ABPM) were examined. Patients who reached the ABPM standard were divided into white coat effect (n = 112) and control (n = 432) groups according to the results of the office blood pressure. The degree of anxiety in the two groups was evaluated using the Self-rating Anxiety Scale (SAS) and the Beck Anxiety Scale (BAI). Differences in anxiety, gender, age, number of antihypertensive drugs, cost per tablet and marital status were analyzed.

Results: There was no significant difference in the degree of anxiety between the white coat and control groups, with mean SAS standard scores of 32.8 8.5 . 31.8 9.9, respectively ( = 0.170). Similarly, the mean BAI standard scores were 31.4 8.3 . 31.2 9.5, respectively ( = 0.119). Logistic regression analysis showed that the factors of female gender ( = -1.230, 0.001), old age ( = 0.216, 0.001), number of antihypertensive drugs ( = 1.957, 0.001), and cost per tablet ( = 1.340, 0.001) were significantly related to the white coat effect.

Conclusions: Anxiety was not necessary for the white coat effect in hypertension patients during treatment. Female gender, old age, number of antihypertensive drugs used and cost per tablet were related to the white coat effect in hypertension patients during treatment.

References

Terracciano A, Scuteri A, Strait J, Sutin A, Meirelles O, Marongiu M . Are personality traits associated with white-coat and masked hypertension?. J Hypertens. 2014; 32(10):1987-92. PMC: 4196211. DOI: 10.1097/HJH.0000000000000289. View

Oyola M, Handa R . Hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes: sex differences in regulation of stress responsivity. Stress. 2017; 20(5):476-494. PMC: 5815295. DOI: 10.1080/10253890.2017.1369523. View

Pioli M, Ritter A, Faria A, Modolo R . White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control. 2018; 11:73-79. PMC: 6233698. DOI: 10.2147/IBPC.S152761. View

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M . 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31(7):1281-357. DOI: 10.1097/01.hjh.0000431740.32696.cc. View

Johnson H . Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension. Curr Hypertens Rep. 2019; 21(9):66. DOI: 10.1007/s11906-019-0972-5. View

Nuredini G, Saunders A, Rajkumar C, Okorie M . Current status of white coat hypertension: where are we?. Ther Adv Cardiovasc Dis. 2020; 14:1753944720931637. PMC: 7318827. DOI: 10.1177/1753944720931637. View

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M . 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33):3021-3104. DOI: 10.1093/eurheartj/ehy339. View

Amigo I, Cuesta V, Fernandez A, Gonzalez A . The effect of verbal instructions on blood pressure measurement. J Hypertens. 1993; 11(3):293-6. DOI: 10.1097/00004872-199303000-00010. View

Mancia G, Bertinieri G, Grassi G, Parati G, Pomidossi G, Ferrari A . Effects of blood-pressure measurement by the doctor on patient's blood pressure and heart rate. Lancet. 1983; 2(8352):695-8. DOI: 10.1016/s0140-6736(83)92244-4. View

10.

Siddiqui M, Judd E, Oparil S, Calhoun D . White-Coat Effect Is Uncommon in Patients With Refractory Hypertension. Hypertension. 2017; 70(3):645-651. PMC: 5552439. DOI: 10.1161/HYPERTENSIONAHA.117.09464. View

11.

Sze Y, Brunton P . Sex, stress and steroids. Eur J Neurosci. 2019; 52(1):2487-2515. DOI: 10.1111/ejn.14615. View

12.

Feitosa A, Mota-Gomes M, Barroso W, Miranda R, Barbosa E, Pedrosa R . Relationship between office isolated systolic or diastolic hypertension and white-coat hypertension across the age spectrum: a home blood pressure study. J Hypertens. 2019; 38(4):663-670. DOI: 10.1097/HJH.0000000000002320. View

13.

Ogedegbe G . Causal mechanisms of masked hypertension: socio-psychological aspects. Blood Press Monit. 2010; 15(2):90-2. DOI: 10.1097/MBP.0b013e3283380df5. View

14.

Hanninen M, Niiranen T, Puukka P, Kesaniemi Y, Kahonen M, Jula A . Target organ damage and masked hypertension in the general population: the Finn-Home study. J Hypertens. 2013; 31(6):1136-43. DOI: 10.1097/HJH.0b013e32835fa5dc. View

15.

Smolensky M, Hermida R, Portaluppi F . Circadian mechanisms of 24-hour blood pressure regulation and patterning. Sleep Med Rev. 2016; 33:4-16. DOI: 10.1016/j.smrv.2016.02.003. View

16.

Whelton P, Carey R, Aronow W, Casey Jr D, Collins K, Himmelfarb C . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on.... Hypertension. 2017; 71(6):e13-e115. DOI: 10.1161/HYP.0000000000000065. View

17.

Cobos B, Haskard-Zolnierek K, Howard K . White coat hypertension: improving the patient-health care practitioner relationship. Psychol Res Behav Manag. 2015; 8:133-41. PMC: 4427265. DOI: 10.2147/PRBM.S61192. View

18.

Graham N, Smith D . Comorbidity of depression and anxiety disorders in patients with hypertension. J Hypertens. 2016; 34(3):397-8. DOI: 10.1097/HJH.0000000000000850. View

19.

Humbert X, Fedrizzi S, Alexandre J, Menotti A, Manrique A, Laurenzi M . Impact of Sex on Office White Coat Effect Tail: Investigating Two Italian Residential Cohorts. Sci Rep. 2019; 9(1):17237. PMC: 6872870. DOI: 10.1038/s41598-019-53109-1. View

20.

Li Y, Buys N, Li Z, Li L, Song Q, Sun J . The efficacy of cognitive behavioral therapy-based interventions on patients with hypertension: A systematic review and meta-analysis. Prev Med Rep. 2021; 23:101477. PMC: 8278424. DOI: 10.1016/j.pmedr.2021.101477. View