ArticleArchives of internal medicine2008
The misdiagnosis of hypertension: the role of patient anxiety.
Article in Archives of internal medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
52 citing papers in PubMed, 3 syntheses or guidelines pooled it, 131 citations in OpenAlex.
- Options for the diagnosis of high blood pressure in primary care: a systematic review and economic model.Journal of human hypertension · 2021Pooled it
- Pooled it
- Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review.BMJ (Clinical research ed.) · 2011Pooled it
- Are there consequences of labeling patients with prehypertension? An experimental study of effects on blood pressure and quality of life.Journal of psychosomatic research · 2013Trial
- Accuracy of blood pressure measurements reported in an electronic medical record during routine primary care visits.Journal of clinical hypertension (Greenwich, Conn.) · 2011Trial
- Association Between Symptoms of Anxiety and Depression and Blood Pressure Variability in Older Outpatients.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026Observational
- Detection of previously undiagnosed conditions in midlife preventive health examinations.Scientific reports · 2026Article
- "Implementation Hypertension" in the pandemic era: unmasking white-coat effects in healthcare workers.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Prevalence of hypertension and related factors among suspected hypertensive medical personnel during COVID-19 vaccination.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic.BMJ open quality · 2025Article
- Acute Effects of Four Major Trace Amines on Zebrafish Behavioral, Neurochemical, and Neuroendocrine Responses.Journal of neurochemistry · 2025Article
- Disease Acceptance and Stress as Factors Explaining Preoperative Anxiety and the Need for Information in Patients Undergoing Operative Minihysteroscopy.Journal of clinical medicine · 2025Article
- Sensitivity Analysis for Binary Outcome Misclassification in Randomization Tests via Integer Programming.Journal of computational and graphical statistics : a joint publication of American Statistical Association, Institute of Mathematical Statistics, Interface Foundation of North America · 2025Article
- Pain Severity During Hysteroscopy by GUBBINI System in Local Anesthesia: Covariance Analysis of Treatment and Effects, Including Patient Emotional State.Journal of clinical medicine · 2024Article
- Neighborhood Deprivation, Perceived Stress, and Pregnancy-Related Hypertension Phenotypes a Decade Following Pregnancy.American journal of hypertension · 2024Article
- Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study.Advances in orthopedics · 2023Article
- Article
- Occupational exposure to particles and biomarkers of cardiovascular disease-during work and after vacation.International archives of occupational and environmental health · 2022Article
- Mental and Body Health: The Association between Psychological Factors, Overweight, and Blood Pressure in Young Adults.Journal of clinical medicine · 2022Article
- "What if It's not Just an Item of Clothing?" - A Narrative Review and Synthesis of the White Coat in the Context of Aged Care.Psychologica Belgica · 2022Review
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundThe 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.
methodsA 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.
resultsA 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 (F(3,237) = 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).
conclusionsThese 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.