A randomised controlled trial of the effect of anticipation of a blood test on blood pressure

Marshall, Tom; Anantharachagan, A; Choudhary, Kamla; Chue, Colin D.; Kaur, Inder Preet

doi:10.1038/sj.jhh.1001460

Cited by 12 publications

(9 citation statements)

References 16 publications

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“…Given the instructions simply required cognitive understanding of the upcoming task and was therefore psychological in nature, it would seem that the MAST instructions alone can be a considerable psychological stressor. BP has seldom been studied in anticipation to stress, but our results do support previous findings that SBP increased in anticipation of a physical stressor (blood test) (Marshall et al, 2002). However, we also showed the same anticipation effect in DBP, while Marshall et al (2002) did not.…”

Section: Discussionsupporting

confidence: 90%

“…BP has seldom been studied in anticipation to stress, but our results do support previous findings that SBP increased in anticipation of a physical stressor (blood test) (Marshall et al, 2002). However, we also showed the same anticipation effect in DBP, while Marshall et al (2002) did not. Given the MAST consists of both physiological and psychological stressors, it is unknown if one or both components are eliciting the anticipatory BP increases, and future research should consider the impact of the type of task on anticipatory responses.…”

Section: Discussionsupporting

confidence: 90%

“…While anticipation of a psychosocial stressor (evaluated speech) has been reported to increase heart rate in women with higher levels of trait anxiety (Gonzalez-Bono et al, 2002), anticipation of physical stressors involving pain has been observed to lead to a reduction in heart rate in both human and animal samples (see Alm, 2004 for review). Furthermore, although there are limited studies on the anticipatory effects on BP, Marshall et al (2002) demonstrated that systolic blood pressure (SBP), but not diastolic blood pressure (DBP), significantly increased from baseline after being told a blood test was imminent, suggesting that activation of the SAM axis may differ depending on the type of stressor, pre-existing levels of anxiety (and depression), and the timing of the measure relative to the stressor.…”

Section: Introductionmentioning

confidence: 99%

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The Maastricht Acute Stress Test (MAST): Physiological and Subjective Responses in Anticipation, and Post-stress

Shilton

Laycock

2017

Front. Psychol.

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The Maastricht Acute Stress Test (MAST) is designed to be a simple, quick, and non-invasive procedure aimed at activating the human stress system. The MAST has been developed by combining elements from two of the most common experimental paradigms measuring stress, the Trier Social Stress Test and the Cold Pressor Test. The aim of this study was to use the MAST procedure to elicit strong autonomic and subjective stress responses that can be quantified in terms of (systolic and diastolic) blood pressure, pulse rate (PR), and state anxiety ratings. In healthy individuals, the MAST induced a significant elevation of systolic blood pressure (SBP) from baseline for up to 30 min post-MAST, while diastolic blood pressure (DBP) dropped to baseline within 10 min post-MAST. Interestingly, the presentation of instructions alerting participants to the procedure resulted in significant elevation of both SBP and DBP above baseline. However, BP measurements prior to test initiation were not as high as those measured immediately after the MAST procedure. PR data showed limited variability across time points. Self-reported state anxiety increased dramatically from baseline to immediately following the MAST procedure. Further, individuals who reported higher levels of depression and stress were more likely to demonstrate larger increases in SBP in response to the MAST. Together, these results support the use of the MAST as a useful tool to activate both acute physiological and subjective measures of the stress response in healthy adults lasting up to 30 min.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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The Maastricht Acute Stress Test (MAST): Physiological and Subjective Responses in Anticipation, and Post-stress

Shilton

Laycock

2017

Front. Psychol.

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“…The presence of a final-year medical student during examination, 3 the prospect of a blood test being taken 4 and an insufficient rest period before measurement 5 can all increase the observed BP. An inadequate cuff size 6 and various other factors such as cold, pain or a full bladder 7 can also affect the measured BP.…”

Section: Introductionmentioning

confidence: 99%

Variation in recorded blood pressure terminal digit bias in general practice

2007

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This study aims to identify the extent of terminal digit bias in routinely recorded blood pressures (BP) across a number of different general practices and report on changes in terminal digit bias over a 10-year period. It also explores the effect this may have had on the mean recorded BP in this population. BP records were taken from The Health Improvement Network database containing anonymized patient records from information entered by UK general practices in the financial years 1996-1997 to [2005][2006]. The proportion of measurements ending in zero and the mean BP readings were calculated for each practice and for each year of data. Over this 10-year period the percentage of systolic BPs with zero terminal digits fell from 71.2 to 36.7% and mean recorded BP fell from 152.3 to 145.3 mm Hg. Correcting the BPs to remove terminal digit bias indicates a 2-3 mm Hg underestimation of the mean population systolic BP over this period. The between-practice variation in the percentage of zero terminal digit readings increased from 3.5 to 6.5 s.d. Although it is welcome to see a reduction in terminal digit bias, it is worrying to see the increase in variation between practices. There is evidence that terminal digit bias may lead to potential misclassification and inappropriate treatment of hypertensive patients. The increase in variation observed may therefore lead to an increased variation in the quality of care given to patients.

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“…They find that the presence of a final-year medical student raises measured blood pressure by 4.8/1.7 mmHg. Others have drawn attention to widespread use of uncalibrated sphygmomanometers, 2 zero-digit bias, 3 the effects of taking blood tests, 4 the influence of the rest period, 5 cuff size, 6 and a number of other factors on measured blood pressure. 7 Attention has been drawn to the misclassification that results from measuring something as intrinsically variable as blood pressure.…”

mentioning

confidence: 99%