Abstract P221: Physicians are More Prone to Causing White Coat Hypertension than Nurses or Cardiovascular Technicians: An Observational Study
Introduction: Accurate assessments of blood pressure (BP) are critical for the effective diagnosis and treatment of hypertension. A substantial portion of patients labelled hypertensive have been shown to instead have White Coat Hypertension (WCH), where their BP is elevated exclusively when assessed in a clinic. In this study, we assessed whether the type of healthcare provider measuring individuals’ blood pressure impacted the incidence of WCH.
Methodology: Following collection of baseline demographics, 106 participants had their BP measured by a physician, a nurse and a cardiovascular technician. The order of measurements was randomized. All healthcare providers used the same BP cuff for measurements and were instructed to measure BP following a standardized method. Following BP readings taken by healthcare providers, a 24-hour Ambulatory Blood Pressure Monitor (ABPM) was applied to all participants. The average of the daytime readings of the ABPM served as the control for this study.
Results: Patients whose BP were greater than 140/90 mm Hg when measured by a healthcare provider, but whose control readings by ABPM were less than 135/85 mm Hg were classified as having WCH. Physicians caused 33% of participants (35 of 106) to have WCH. Nurses caused 23.5% of participants (25 of 106) to have WCH. Cardiovascular technicians caused 5.6% of participants (6 of 106) to have WCH. (p<0.0001).
Similar trends were observed based on analysis examining the percentage of accurate readings and the average of readings compared to the control ABPM, with technicians having the most accurate readings, nurses having moderately accurate readings, and physicians having the least accurate readings.
Conclusions: The results of this study suggest that the incidence of WCH and BP measurement inaccuracy occur more frequently when BP is assessed by certain types of healthcare providers, potentially because patients may feel more anxious or stressed around these individuals. It may therefore be advisable for BP to be assessed by cardiovascular technicians, instead of nurses or physicians, to reduce the risk of White Coat Hypertension and inaccurate BP readings.
Author Disclosures: A.K. Pandey: None.
- © 2015 by American Heart Association, Inc.