Psychological constructs involved in emotional blood pressure response and white coat phenomenon

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ASH XV ABSTRACTS

sives. This may reflect differing underlying mechanisms of hypertension in these age groups. Key Words: Age; ambulatory blood pressure; prognosis

C024 BETTERING BLOOD PRESSURE CONTROL IN CLINICAL PRACTICE: ROLE OF AMBULATORY BLOOD PRESSURE MONITORING G. Crippa*, E. Sverzellati, P. Antoniotti, and G.C. Carrara. Hypertension Unit, Civil Hospital, Piacenza, Italy The routine clinical use of ambulatory blood pressure monitoring (ABPM) is still controversial, mainly because this technique adds a considerable cost to the already expensive treatment of hypertension. However, considering that epidemiological surveys still indicate that well-controlled hypertensive patients are only a minority, all the tools that may potentially ameliorate BP control should be considered for clinical practice. The aim of the present study was to assess the prevalence of satisfactory blood pressure (PB) control in patients followed up with ABPM in our hypertension unit. We retrospectively analyzed BP control levels in 120 consecutive patients who had been routinely controlled with ABPMs performed every 6 –12 months. Inclusion criteria were: sustained mild-moderate hypertension with a duration ⱖ3 years, continuous pharmacological treatment and at least 3 valid ABPMs in the last 2 years. A 24-hour mean BP ⬍ 135/85 mm Hg was considered as effective BP control. The results have been compared with those obtained in a group of 120 patients (comparable as far as age, gender distribution, duration of hypertension are concerned) controlled through clinic BP and who underwent their first ABPM in our unit. Seventy-two percent of the 120 hypertensive patients followed up with ABPM showed well controlled BP, while in the control group only 38% had satisfactory BP levels (p ⬍ 0.001, Fisher’s exact probability test). Fourteen percent of the patients who regularly underwent ABPM were taking more than 2 antihypertensive drugs, while 28% of the patients followed up with clinic BP measurements were taking more than 2 drugs. Our data indicate that, in a specialized clinic, the routine use of ABPM in mild-moderate hypertensive patients may significantly improve BP control. ABPM, providing more detailed and repeatable information on blood pressure status, might also reduce the need of polypharmacotherapy which may consistently affect patients’ compliance and, therefore, BP control. Key Words: Ambulatory blood pressure monitoring, antihypertensive treatment, blood pressure control

C025 PSYCHOLOGICAL CONSTRUCTS INVOLVED IN EMOTIONAL BLOOD PRESSURE RESPONSE AND WHITE COAT PHENOMENON G. Crippa*, O. Bettinardi, G. Calandraa, P.L. Bertolettia, P. Mizzib, L. Re’b, E. Sverzellatiគ, P. Antoniotti, G.C. Carrara, and A. Mostia. Hypertension Unit, aSERT, Civil Hospital, bS. Giacomo Rehabilitation Institute, Piacenza, Italy

AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2

Some hypertensive or non-hypertensive patients have an impressive pressure response to medical environment (white coat phenomenon) but its presence, amplitude and duration is unlikely to be predicted routinely. Despite the common observations that “anxious” patients may have, in the medical environment, marked blood pressure (BP) increase, no psychological variable had been linked before, in formal analyses to white coat phenomenon. To investigate the possible relationships between patient’s psychological profile and white coat phenomenon 70 patients undergoing ambulatory blood pressure (ABP) monitoring have been studied. Thirty-five patient who presented white coat phenomenon (defined as office BP ⬎ 20% of mean 24-hour ABP values) and 35 comparable patients who did not present with this reaction underwent the following psychometric tests: Cognitive Behavioral Assessment H (CBAH), Multidimensional Anger Inventory (MAI), State-Trait Anger Inventory (STAXI), Hostility Inventory (HO), Satisfaction Profile (SAT-P), and Coping Orientation to Problems Experienced (COPE). Particularly, the analysis of the COPE showed a significant difference between patients with and without white coat phenomenon in 3 scales: planning, suppression of competitive activities, and mental disengagement. White coat phenomenon appears to be linked (p ⬍ 0.025, Fisher’s exact probability test) to psychological constructs characterized by high coping and planning ability but also by a high avoiding strategy. Theses data indicate that patients who do not define themselves as “anxious”, reveal high coping and planning capabilities addressed toward the cognitive resolution of a stressing situation (such as BP measurement), but do not accompany these strategies with an adequate behavioral response, are likely to show an overt BP increase in the medical environment. Key Words: White coat phenomenon; ambulatory blood pressure; COPE test; psychological profile C026 ANALYSIS OF THE HYPERTENSION CONTROL BY ROUTINE MEASUREMENT VS. AMBULATORY BLOOD PRESSURE MONITORING L.R. Cavichio, R. Po´voa*, M. Shirassu, J. Pimenta. Dept of Cardiology, Hospital do Servidor Pu´blico Estadual, Sa˜o Paulo, Brazil NHANES III indicated that patients with high blood pressure (BP) under treatment in the USA are about 53% and only 27% had their BP controlled. Our objective was evaluate the rate of patients under treatment in the Hypertension Clinic as well as the rate of patients effectively controlled (BP ⬍ 140/90 mmHg). Four-hundred and twenty three individuals were evaluated, mean age of 59.9 years, 322 (76.1%) women, during 6 month follow-up. Patients had the BP measured in the supine position, 3 times in the Clinic office with 10 minute intervals and the lowest values were considered. In 12.5% of the uncontrolled patients in spite of appropriate antihypertensive drug treatment, ambulatory BP monitoring (ABPM) was performed in order to evaluate the out-of-hospital behavior of the BP. Of this population, 354 (83.6%) confirmed regular drug treatment, 28 (6.7%) did not have taken the medication on the day of the evaluation,