Document Detail

The importance of the clinical observer in the development of a white-coat effect in African-American patients with hypertension.
MedLine Citation:
PMID:  18496287     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: As the office-awake blood pressure (BP) difference (white-coat effect) in African-Americans has not been evaluated, we studied the ethnicity, professional status (nurse versus doctor) and sex of the observer on the white-coat effect in African-American patients with hypertension. METHODS: Seated clinical BP measurements were obtained in random order by an African-American male research physician, a Caucasian male research physician, and a Caucasian female nurse who is of similar age and clinical experience. Within 1 week, ambulatory BP recordings were performed. RESULTS: A total of 65 African-American patients [54+/-13 years, 55% women, body mass index (BMI) 31+/-6 kg/m, 62% on drug therapy, 28% current smokers] participated in the study. Twenty-two percent had a systolic white-coat effect >20 mmHg and 49% had a diastolic white-coat effect >10 mmHg (average of all observers). Although there were no differences in the magnitude of the white-coat effect among the three study observers, the primary physician's diastolic white-coat effect was significantly greater than that of the African-American physician (14+/-12 vs. 9+/-12, P=0.05), but not the systolic white-coat effect (16+/-16 vs. 10+/-16 mmHg, P=0.09). BMI positively correlated with the systolic and diastolic white-coat effect (r=0.30, P=0.02 and r=0.41, P=0.0001), but this correlation was true only for female patients in multiple regression analyses. BMI significantly predicted the systolic (P=0.043) and diastolic (P=0.004) white-coat effects. CONCLUSION: A white-coat effect is relatively common in African-American patients with hypertension and is the largest when the observer is their usual doctor. The clinical observer's ethnicity or sex does not play an important role in generating a white-coat effect in African-American patients with hypertension.
Paul T Labinson; Sharon Giacco; Henry Gift; George A Mansoor; William B White
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Blood pressure monitoring     Volume:  13     ISSN:  1359-5237     ISO Abbreviation:  Blood Press Monit     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-22     Completed Date:  2008-08-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9606438     Medline TA:  Blood Press Monit     Country:  England    
Other Details:
Languages:  eng     Pagination:  139-42     Citation Subset:  IM    
Section of Hypertension and Clinical Pharmacology, Center for Cardiology and Cardiovascular Biology, University of Connecticut School of Medicine, Farmington, Connecticut 06030-3949, USA.
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MeSH Terms
African Americans*
Blood Pressure Determination
Blood Pressure Monitoring, Ambulatory*
Body Mass Index
European Continental Ancestry Group
Hypertension / diagnosis*,  ethnology*
Middle Aged
Physician-Patient Relations*
Sex Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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