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

被引:6
作者
Bo, Mario [1 ,2 ]
Comba, Monica [1 ,2 ]
Canade, Antonella [1 ,2 ]
Brescianini, Alessia [1 ,2 ]
Corsinovi, Laura [1 ,2 ]
Astengo, Marco A. [1 ,2 ]
Sona, Alessandro [1 ,2 ]
Fonte, Gianfranco [1 ,2 ]
机构
[1] Univ Turin, Dipartimento Discipline Med Chirurg, Sezione Geriatria, I-10124 Turin, Italy
[2] Azienda Osped San Giovanni Battista, I-10126 Turin, Italy
关键词
white-coat effect; blood pressure monitoring; lipid clinic; primary prevention;
D O I
10.1016/j.atherosclerosis.2007.08.007
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We evaluated clinical implications of the white-coat effect (WCE) in cardiovascular (CV) risk stratification in the primary prevention setting of a Lipid Clinic. We compared home self blood pressure measurement (SBPM) with office blood pressure (BP) readings and BP measured by a nurse before and after the visit on consecutive subjects, free of previous CV diseases, attending at a Lipid Clinic for a first visit. Additionally, we evaluated whether and to what extent the difference between these measurements affect the 10-year cardiovascular risk calculated according to current guidelines. Mean home self-measured systolic and diastolic BP values were significantly lower than physician's and nurse's readings (P = 0.000). A WCE was observed in 60.3% of patients during the physician's visit, and in 33.9% and 36.6% of nurse's measurements before and after visit, respectively. Compared with computation of SBPM, inclusion in risk predictive model of systolic BP values obtained by physician and nurse (before or after visit) resulted in significantly higher calculated CV risk (p = 0.000) and in a higher risk-class allocation in 16.5%, 8.5% and 9.4% of patients, respectively (p = 0.000). Our findings show that among patients attending at a Lipid Clinic there is a high prevalence of WCE, which is roughly halved when nurse's BP measurements were considered. Nurse's BP measurements before or after the doctor's visit may reduce, but not eliminate at all, the clinic overestimation of BP. The WCE associated with physician's office visit carries a substantial probability of 10-year CV risk overestimation in the primary prevention setting. (c) 2007 Published by Elsevier Ireland Ltd.
引用
收藏
页码:904 / 909
页数:6
相关论文
共 30 条
[1]   AN UPDATED CORONARY RISK PROFILE - A STATEMENT FOR HEALTH-PROFESSIONALS [J].
ANDERSON, KM ;
WILSON, PWF ;
ODELL, PM ;
KANNEL, WB .
CIRCULATION, 1991, 83 (01) :356-362
[2]  
[Anonymous], 1995, PHYS STAT UINT ANT
[3]   Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Munster (PROCAM) study [J].
Assmann, G ;
Cullen, P ;
Schulte, H .
CIRCULATION, 2002, 105 (03) :310-315
[4]   Body fat and C-reactive protein levels in healthy non-obese men [J].
Bo, M ;
Raspo, S ;
Morra, F ;
Isaia, G ;
Cassader, M ;
Fabris, E ;
Poli, L .
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES, 2004, 14 (02) :66-72
[5]   Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) [J].
Cleeman, JI ;
Grundy, SM ;
Becker, D ;
Clark, LT ;
Cooper, RS ;
Denke, MA ;
Howard, WJ ;
Hunninghake, DB ;
Illingworth, DR ;
Luepker, RV ;
McBride, P ;
McKenney, JM ;
Pasternak, RC ;
Stone, NJ ;
Van Horn, L ;
Brewer, HB ;
Ernst, ND ;
Gordon, D ;
Levy, D ;
Rifkind, B ;
Rossouw, JE ;
Savage, P ;
Haffner, SM ;
Orloff, DG ;
Proschan, MA ;
Schwartz, JS ;
Sempos, CT ;
Shero, ST ;
Murray, EZ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (19) :2486-2497
[6]   Estimation of ten-year risk of fatal cardiovascular disease in Europe:: the SCORE project [J].
Conroy, RM ;
Pyörälä, K ;
Fitzgerald, AP ;
Sans, S ;
Menotti, A ;
De Backer, G ;
De Bacquer, D ;
Ducimetière, P ;
Jousilahti, P ;
Keil, U ;
Njolstad, I ;
Oganov, RG ;
Thomsen, T ;
Tunstall-Pedoe, H ;
Tverdal, A ;
Wedel, H ;
Whincup, P ;
Wilhelmsen, L ;
Graham, IM .
EUROPEAN HEART JOURNAL, 2003, 24 (11) :987-1003
[7]   Isolated clinic hypertension in a general population [J].
Cuspidi, C ;
Parati, G .
JOURNAL OF HYPERTENSION, 2006, 24 (03) :437-440
[8]   Assessment of the white-coat effect [J].
Gerin, W ;
Ogedegbe, G ;
Schwartz, JE ;
Chaplin, WF ;
Goyal, T ;
Clemow, L ;
Davidson, KW ;
Burg, M ;
Lipsky, S ;
Kentor, R ;
Jhalani, J ;
Shimbo, D ;
Pickering, TG .
JOURNAL OF HYPERTENSION, 2006, 24 (01) :67-74
[9]   Ambulatory blood pressure monitoring and risk of cardiovascular disease: A population based study [J].
Hansen, TW ;
Jeppesen, J ;
Rasmussen, S ;
Ibsen, H ;
Torp-Pedersen, C .
AMERICAN JOURNAL OF HYPERTENSION, 2006, 19 (03) :243-250
[10]   White coat effect and reactivity to stress - Cardiovascular and autonomic nervous system responses [J].
Lantelme, P ;
Milon, H ;
Gharib, C ;
Gayet, C ;
Fortrat, JO .
HYPERTENSION, 1998, 31 (04) :1021-1029