The Misdiagnosis of Hypertension

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

doi:10.1001/archinte.168.22.2459

Cited by 108 publications

(54 citation statements)

References 25 publications

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“…Given the mixed evidence from previous studies [7, 11, 16], it is unlikely that there are large main effects of neuroticism or anxiety on masked hypertension. The moderation analyses suggest that among those taking antihypertensive medications, lower conscientiousness predicted higher risk of masked uncontrolled hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in a study of 238 hypertensive patients, those with white coat hypertension experienced significantly higher levels of anxiety during BP measurement in the clinic [7]. Anxiety and other forms of psychological distress, however, may have greater effects among those taking antihypertensive medications or who are otherwise aware of their hypertensive status [8, 9].…”

Section: Introductionmentioning

confidence: 99%

“…A recent study suggests that those with masked hypertension scored lower on a measure of depressed mood and type-A personality compared to white coat and sustained hypertension groups [11]. Other studies have found that masked hypertension is associated with hypochondria and depression [16], but not anxiety [7]. …”

Section: Introductionmentioning

confidence: 99%

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Are personality traits associated with white-coat and masked hypertension?

Terracciano

Scuteri

Strait

et al. 2014

Journal of Hypertension

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Objectives Anxiety and other psychological dispositions are thought to be associated with blood pressure. This study tests whether personality traits have long-term associations with masked and white coat effects. Methods A community-based sample of 2,838 adults from Sardinia (Italy) completed the Revised NEO Personality Inventory and seven years later blood pressure was assessed in the clinic and with ambulatory monitoring. Logistic regressions were used to test whether anxiety, neuroticism, extraversion, openness, agreeableness, and conscientiousness predicted the white coat and masked hypertension phenomena. Age, sex, and antihypertensive medication use were tested as moderators. Results Significant interactions were found between personality traits and antihypertensive medications in predicting masked and white coat effects. Only among those taking antihypertensive medication, higher anxiety was associated with a higher risk of pseudo-resistant hypertension due to white coat effect (OR = 1.39, 95%CI = 1.01–1.91) and higher conscientiousness was associated with a lower risk of masked uncontrolled hypertension (OR = 0.70, 95%CI = 0.49–0.99). There were no significant interactions with age or sex. Conclusions Among those on antihypertensive medications, anxious individuals were more likely to have pseudo-resistant hypertension due to white coat effect and less conscientious individuals were at increased risk of masked uncontrolled hypertension. Particularly among anxious and less conscientious individuals, ambulatory monitoring may improve the tailoring of pharmacological treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Are personality traits associated with white-coat and masked hypertension?

Terracciano

Scuteri

Strait

et al. 2014

Journal of Hypertension

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“…However, systematic group differences in the elicited cognitive state could also lead to smaller differences in resting-state brain activity than would have been observed if the groups were balanced for their cognitive states. Furthermore, cognitive states that are secondary to the clinical condition, such as arousal or comfort (Ogedegbe et al, 2008), could bias the dynamic measures derived from functional neuroimaging data. In all of these situations, information about participants' cognitive state could potentially improve the interpretation or increase the sensitivity and specificity of neuroimaging biomarkers in clinical of pharmacological studies (Klumpers et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

The Amsterdam Resting-State Questionnaire reveals multiple phenotypes of resting-state cognition

Díaz¹,

Sluis²,

Moens³

et al. 2013

Front. Hum. Neurosci.

158

193

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Resting-state neuroimaging is a dominant paradigm for studying brain function in health and disease. It is attractive for clinical research because of its simplicity for patients, straightforward standardization, and sensitivity to brain disorders. Importantly, non-sensory experiences like mind wandering may arise from ongoing brain activity. However, little is known about the link between ongoing brain activity and cognition, as phenotypes of resting-state cognition—and tools to quantify them—have been lacking. To facilitate rapid and structured measurements of resting-state cognition we developed a 50-item self-report survey, the Amsterdam Resting-State Questionnaire (ARSQ). Based on ARSQ data from 813 participants assessed after 5 min eyes-closed rest in their home, we identified seven dimensions of resting-state cognition using factor analysis: Discontinuity of Mind, Theory of Mind, Self, Planning, Sleepiness, Comfort, and Somatic Awareness. Further, we showed that the structure of cognition was similar during resting-state fMRI and EEG, and that the test-retest correlations were remarkably high for all dimensions. To explore whether inter-individual variation of resting-state cognition is related to health status, we correlated ARSQ-derived factor scores with psychometric scales measuring depression, anxiety, and sleep quality. Mental health correlated positively with Comfort and negatively with Discontinuity of Mind. Finally, we show that sleepiness may partially explain a resting-state EEG profile previously associated with Alzheimer's disease. These findings indicate that the ARSQ readily provides information about cognitive phenotypes and that it is a promising tool for research on the neural correlates of resting-state cognition in health and disease.

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“…These automated BP devices can eliminate errors, such as digit preference, that are common in manual measurements. Moreover, automated BP monitors can assess BP without a doctor or nurse being present, can automatically take multiple readings, and, therefore, may reduce the white coat effect 1-3 , which is believed to be a conditioned anxiety response 4-6 . It has been reported previously that automated BP readings using the BpTRU device tend to be lower than readings taken by a doctor using a mercury sphygmomanometer (Sphyg) in the usual clinic settings 1, 2, 7 ; however, the automated BP was compared with OBP taken by family physicians in a busy clinical practice or with OBP measured by technicians at the time of ABP monitoring.…”

Section: Introductionmentioning

confidence: 99%

Automatic office blood pressure measured without doctors or nurses present

Ishikawa

Nasothimiou

Karpettas

et al. 2012

Blood Pressure Monitoring

Self Cite

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Backgrounds We evaluated the agreement between office blood pressure (OBP) measured by mercury sphygmomanometer (Sphyg) and automatic (Auto) device without any observers, and compared Auto and Sphyg OBP to ambulatory (ABP) and home blood pressure (HBP). Methods OBP was measured in 75 hypertensive patients at 2 sites using an automatic monitor without a doctor or nurse present and by Sphyg during 3 clinic visits. Between visits, ABP and HBP monitoring were also performed. Results Mean Auto OBP was similar to Sphyg OBP and they were closely correlated (ICC=0.84 for systolic and 0.91 for diastolic OBPs); however, the difference between Auto and Sphyg systolic OBP (1.6±8.2 mmHg) varied by the first office visit, gender, and the site. Auto systolic OBP was lower than both systolic awake ABP (137.1±14.7 mmHg) and HBP (139.2±15.6 mmHg). Auto systolic OBP and Sphyg OBP were similarly correlated with systolic awake ABP (both r=0.59, P<0.001). Mean Auto diastolic OBP was similar to Sphyg OBP (81.1±11.3 vs. 80.3±13.3 mmHg, P=0.20, ICC=0.91), diastolic awake ABP and HBP. Auto diastolic OBP and Sphyg OBP were related to diastolic awake ABP (both r>0.68, P<0.001). In multivariable analyses, neither OBP measure was a significantly stronger predictor of out-of-office BP than the other. Conclusion Auto systolic OBP measured without a doctor or nurse present was lower than systolic awake ABP and HBP. Auto and rigorously assessed Sphyg OBP had similar means and were similarly related to awake ABP. Auto OBP might be an advantageous alternative to Sphyg measurements in the usual clinic setting.

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The Misdiagnosis of Hypertension

Cited by 108 publications

References 25 publications

Are personality traits associated with white-coat and masked hypertension?

Are personality traits associated with white-coat and masked hypertension?

The Amsterdam Resting-State Questionnaire reveals multiple phenotypes of resting-state cognition

Automatic office blood pressure measured without doctors or nurses present

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