The white-coat effect is unrelated to the difference between clinic and daytime blood pressure and is associated with greater reactivity to public speaking

Palatini, Paolo; Palomba, Daniela; Bertolo, Olivo; Minghetti, Rita; Longo, Daniele; Sarlo, Michela; Pessina, Achille C.

doi:10.1097/00004872-200303000-00020

Cited by 53 publications

(43 citation statements)

References 26 publications

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“…Our results are in keeping with previous studies which investigated prevalence and severity of WCE in different settings [2,[4][5][6][21][22][23][24][25][26][27][28], and add further support to the clinical relevance of the WCE even outside traditional hypertensive office settings. Although it has been suggested that it is time to abandon BP readings documented by physicians and general practitioners to make treatment decisions [27], it is not definite whether and which clinic BP readings might surrogate ABPM and SBPM, which have greater prognostic value than office readings [3, 4,14,15], but limited use in daily clinical practice.…”

Section: Discussionsupporting

confidence: 91%

“…Pathophysiological and clinical implications of the WCE have been extensively investigated, mainly in hypertensive patients [2,[4][5][6][21][22][23][24][25][26][27][28]. Although the most common approach is to assess the WCE as the difference between office and average daytime ambulatory or home BP values, this difference does not specifically reflect the acute BP rise induced in the patient by the physician's visit [24][25][26]28].…”

Section: Discussionmentioning

confidence: 99%

“…Although the most common approach is to assess the WCE as the difference between office and average daytime ambulatory or home BP values, this difference does not specifically reflect the acute BP rise induced in the patient by the physician's visit [24][25][26]28]. Number of measures as well as behavioural and environmental factors affecting daytime BP might be more important determinants of the office-daytime BP difference than the alerting effect of the physician's visit.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical implications of white-coat effect among patients attending at a lipid clinic

Comba

Canadè

et al. 2008

Atherosclerosis

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical implications of white-coat effect among patients attending at a lipid clinic

Comba

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et al. 2008

Atherosclerosis

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“…[1][2][3][4][5][6][7] This may be regarded as a physiological reaction, often referred to as the 'fight and flight' phenomenon, or 'defence' or 'alarm' reaction. It is commonly observed in emergency departments of hospitals when patients are frightened, but as highlighted by our study, it may also occur in general practice.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] However, to the best of our knowledge, no published report investigated whether a doctor-in-training when present is a neutral bystander or an obtrusive observer provoking a reactive increase in a patient's blood pressure. The relevance of this research question is underscored by the fact that treatment of hypertension is a frequent reason to consult primary care physicians.…”

Section: Introductionmentioning

confidence: 99%

Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices

et al. 2004

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Until now, no information is available about the effect of the presence of a doctor-in-training on a patient's blood pressure. We tested the hypothesis that the presence of a last year medical student might increase the blood pressure of the patient, in addition to the possible pressor response to the doctor-trainer. Normotensive and hypertensive patients with a minimum age of 25 years, visiting for any reason, were recruited at 22 teaching general practices. Patients were randomised into a 'trainee' group (n ¼ 133) and a 'no trainee' (n ¼ 129) group. The blood pressure was measured at two subsequent contacts. In the 'trainee' group, a student was present at the first visit only. In the 'no trainee' group, both visits were without student. Both groups had similar anthropometric characteristics at entry. At the first visit, systolic pressure was higher in the 'trainee' group than in the control group (139.5 vs 133.1 mmHg, P ¼ 0.004), with a similar trend for diastolic pressure (80.2 vs 77.8 mmHg, P ¼ 0.07). From the first contact to the follow-up visit, blood pressure decreased in the trainee group by 4.8 mmHg systolic (Po0.001) and 1.7 mmHg diastolic (P ¼ 0.03), whereas the corresponding changes in the control group were À0.1 mmHg (P ¼ 0.90) and þ 1.5 mmHg (P ¼ 0.03). Thus, the between group differences in these trends averaging 4.7 mmHg (CI 1.5-7.9, P ¼ 0.005) systolic and 3.2 mmHg (CI 1.1-5.3, P ¼ 0.003) diastolic were statistically significant. We conclude that in teaching-practices, the presence of a doctor-in-training has a significant pressor effect when an experienced general practitioner measures a patient's blood pressure. If confirmed, our findings imply that doctors should be cautious to initiate or adjust antihypertensive treatment when blood pressure readings are obtained in the presence of a student.

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White‐coat effect among older patients with suspected cognitive impairment: prevalence and clinical implications

Massaia

Merlo

et al. 2008

Int J Geriat Psychiatry

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ObjectivesTo evaluate the prevalence of white‐coat effect (WCE), and its association with individual anxiety and insight of disease, among older patients evaluated for suspected cognitive impairment.MethodsThis prospective cohort study, conducted in an Alzheimer Evaluation Unit, involved patients aged 55 years or older with suspected cognitive impairment. WCE was defined as a difference of at least 20 mmHg in systolic or 10 mmHg in diastolic blood pressure (BP) measured either by a physician during the visit or by a nurse (before and after the visit), compared with home self‐blood pressure measurement (SBPM). Severity of cognitive impairment was evaluated through the Mini‐Mental State Examination (MMSE); the Clinical Insight Rating Scale (CIR) and the Guidelines for the Rating for Awareness Deficits (GRAD) were used to evaluate the subject's insight; anxiety disorder was evaluated using the seven‐question Generalized Anxiety Disorder scale (GAD‐7).ResultsAmong 273 subjects, prevalence of WCE was 52%, 32.6% and 30.4%, according to physician and nurse BP measurements, respectively (p = 0.000). Prevalence of WCE did not differ between patients diagnosed with and without dementia, but was higher among patients with than in those without anxiety disorder (70.7% vs 38.2%, p = 0.000). Positive relations were observed between severity of anxiety and insight of disease, which were both inversely related with severity of coginitive impairment.ConclusionsWCE is extremely common and is correlated to individual anxiety and insight of disease among older outpatients with suspected cognitive impairment; overestimation of hypertension severity might lead to unnecessary drug treatment and greater health costs in this setting. Copyright © 2008 John Wiley & Sons, Ltd.

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The white-coat effect is unrelated to the difference between clinic and daytime blood pressure and is associated with greater reactivity to public speaking

Cited by 53 publications

References 26 publications

Clinical implications of white-coat effect among patients attending at a lipid clinic

Clinical implications of white-coat effect among patients attending at a lipid clinic

Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices

White‐coat effect among older patients with suspected cognitive impairment: prevalence and clinical implications

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