Talking Effect and White Coat Phenomenon in Hypertensive Patients

Abstract

Both white coat effect (the tendency of blood pressure to rise during a medical visit) and talking effect were analyzed in 42 patients with essential hypertension. Blood pressure was measured during the clinic visit and over the subsequent 24-hour ambulatory period, with the physician performing 49 +/- 4 measurements for each patient. Three silent periods and two talking periods (stress and relaxation) were randomly allocated in a crossover design and studied, using analysis of variance. During the initial 11-minute silent period, systolic/diastolic blood pressures increased by 6 mm Hg/5 mm Hg. During the subsequent talking periods, these variations were significantly greater: +22 mm Hg/+17 mm Hg. Measures of systolic/diastolic blood pressure were higher during stressful talking than during relaxed talking. The talking and its emotional contents seemed to explain 70% of the white coat phenomenon. To minimize the white coat phenomenon in the clinic, physicians, nurses, and clinicians are advised to measure blood pressure during an initial period of silence.

Health promoting effects of the physician-patient encounter

“…Several studies have indicated that talking provokes cardiovascular reactions (Liehr, 1992;le Pailleur & Landais, 1994;le Pailleur et al, 1996;Stein & Boutcher, 1993). These findings suggest that the verbal activity of talking is, in itself, a sufficient explanation of the white coat phenomenon described above.…”

“…In view of the positive relationship that has been identified between the level of blood pressure and discussion of stressful events (Fontana & McLaughlin, 1998;Liehr et al, 1997;le Pailleur et al, 1996), the content of the words that are spoken (emotional versus neutral) appears to have a greater effect on blood pressure. Individuals seem to respond to a stressful situation like a medical visit with an increase in blood pressure due to conditioning (Nyklṍcek et al, 1998).…”