The misdiagnosis of hypertension: The role of patient anxiety

Gbenga Ogedegbe, Thomas G. Pickering, Lynn Clemow, William Chaplin, Tanya M. Spruill, Gabrielle M. Albanese, Kazuo Eguchi, Matthew Burg, William Gerin

Research output: Contribution to journalArticle

Abstract

Background: The white coat effect (defined as the difference between blood pressure [BP] measurements taken at the physician's office and those taken outside the office) is an important determinant of misdiagnosis of hypertension, but little is known about the mechanisms underlying this phenomenon. We tested the hypothesis that the white coat effect may be a conditioned response as opposed to a manifestation of general anxiety. Methods: A total of 238 patients in a hypertension clinic wore ambulatory blood pressure monitors on 3 separate days 1 month apart. At each clinic visit, BP readings were manually triggered in the waiting area and the examination room (in the presence and absence of the physician) and were compared with the mercury sphygmomanometer readings taken by the physician in the examination room. Patients completed trait and state anxiety measures before and after each BP assessment. Results: A total of 35% of the sample was normotensive, and 9%, 37%, and 19% had white coat, sustained, and masked hypertension, respectively. The diagnostic category was associated with the state anxiety measure (F3,237 = 6.4, P <.001) but not with the trait anxiety measure. Patients with white coat hypertension had significantly higher state anxiety scores (t = 2.67, P <.01), with the greatest difference reported during the physician measurement. The same pattern was observed for BP changes, which generally paralleled the changes in state anxiety (t = 4.86, P <.002 for systolic BP; t = 3.51, P <.002 for diastolic BP). Conclusions: These findings support our hypothesis that the white coat effect is a conditioned response. The BP measurements taken by physicians appear to exacerbate the white coat effect more than other means. This problem could be addressed with uniform use of automated BP devices in office settings.

Original languageEnglish (US)
Pages (from-to)2459-2465
Number of pages7
JournalArchives of Internal Medicine
Volume168
Issue number22
DOIs
StatePublished - Dec 22 2008

Fingerprint

Diagnostic Errors
Anxiety
Blood Pressure
Hypertension
White Coat Hypertension
Physicians
Reading
Masked Hypertension
Blood Pressure Monitors
Sphygmomanometers
Physicians' Offices
Ambulatory Care
Mercury
Equipment and Supplies

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Ogedegbe, G., Pickering, T. G., Clemow, L., Chaplin, W., Spruill, T. M., Albanese, G. M., ... Gerin, W. (2008). The misdiagnosis of hypertension: The role of patient anxiety. Archives of Internal Medicine, 168(22), 2459-2465. https://doi.org/10.1001/archinte.168.22.2459

The misdiagnosis of hypertension : The role of patient anxiety. / Ogedegbe, Gbenga; Pickering, Thomas G.; Clemow, Lynn; Chaplin, William; Spruill, Tanya M.; Albanese, Gabrielle M.; Eguchi, Kazuo; Burg, Matthew; Gerin, William.

In: Archives of Internal Medicine, Vol. 168, No. 22, 22.12.2008, p. 2459-2465.

Research output: Contribution to journalArticle

Ogedegbe, G, Pickering, TG, Clemow, L, Chaplin, W, Spruill, TM, Albanese, GM, Eguchi, K, Burg, M & Gerin, W 2008, 'The misdiagnosis of hypertension: The role of patient anxiety', Archives of Internal Medicine, vol. 168, no. 22, pp. 2459-2465. https://doi.org/10.1001/archinte.168.22.2459
Ogedegbe G, Pickering TG, Clemow L, Chaplin W, Spruill TM, Albanese GM et al. The misdiagnosis of hypertension: The role of patient anxiety. Archives of Internal Medicine. 2008 Dec 22;168(22):2459-2465. https://doi.org/10.1001/archinte.168.22.2459
Ogedegbe, Gbenga ; Pickering, Thomas G. ; Clemow, Lynn ; Chaplin, William ; Spruill, Tanya M. ; Albanese, Gabrielle M. ; Eguchi, Kazuo ; Burg, Matthew ; Gerin, William. / The misdiagnosis of hypertension : The role of patient anxiety. In: Archives of Internal Medicine. 2008 ; Vol. 168, No. 22. pp. 2459-2465.
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