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

Bo, Mario; Comba, Monica; Canadè, Antonella; Brescianini, Alessia; Corsinovi, Laura; Astengo, Marco; Sona, A.; Fonte, Gianfranco

doi:10.1016/j.atherosclerosis.2007.08.007

Cited by 7 publications

(11 citation statements)

References 26 publications

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“…Eleven studies recruited hypertensive subjects from primary health care 25,26 or secondary care clinic settings; [27][28][29][30][31][32][33][34][35] others recruited a combination of normotensive and hypertensive subjects. [36][37][38][39] Studies excluded after assessment are available from the authors on request. 32,34,35 and one study averaged mercury and automated readings.…”

Section: Included Studiesmentioning

confidence: 99%

“…29,32,33 Summary risk of bias judgments were low for seven studies, [25][26][27]30,31,33,34 and high for the remainder (Table 1). 28,29,32,[35][36][37][38][39] Differences in blood pressure measurements Differences in blood pressures measured by doctors and nurses could be pooled for 16 cohorts from 14 studies. Overall systolic measurements by nurses were -7.0 (95% CI = -4.7 to -9.2) mmHg lower than those by doctors; diastolic measurements were -3.8 (95% CI = -2.2 to -5.4) mmHg lower.…”

Section: Included Studiesmentioning

confidence: 99%

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Doctors record higher blood pressures than nurses: systematic review and meta-analysis

Clark

Horvath²,

Taylor³

et al. 2014

Br J Gen Pract

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Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Doctors record higher blood pressures than nurses: systematic review and meta-analysis

Clark

Horvath²,

Taylor³

et al. 2014

Br J Gen Pract

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“…WCE was conventionally defined as a difference of at least 20 mmHg in systolic BP or 10 mmHg in diastolic BP, compared with SBPM (Myers, 1996;Bo et al, 2008;Verberk et al, 2006a). Normotension, sustained hypertension (SH), and ICH were diagnosed according to current European recommendations (European Society of Hypertension/European Society of Cardiology, 2003;O'Brien et al, 2003).…”

Section: Methodsmentioning

confidence: 99%

White‐coat effect among older patients with suspected cognitive impairment: prevalence and clinical implications

Massaia

Merlo

et al. 2008

Int J Geriat Psychiatry

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ObjectivesTo evaluate the prevalence of white‐coat effect (WCE), and its association with individual anxiety and insight of disease, among older patients evaluated for suspected cognitive impairment.MethodsThis prospective cohort study, conducted in an Alzheimer Evaluation Unit, involved patients aged 55 years or older with suspected cognitive impairment. WCE was defined as a difference of at least 20 mmHg in systolic or 10 mmHg in diastolic blood pressure (BP) measured either by a physician during the visit or by a nurse (before and after the visit), compared with home self‐blood pressure measurement (SBPM). Severity of cognitive impairment was evaluated through the Mini‐Mental State Examination (MMSE); the Clinical Insight Rating Scale (CIR) and the Guidelines for the Rating for Awareness Deficits (GRAD) were used to evaluate the subject's insight; anxiety disorder was evaluated using the seven‐question Generalized Anxiety Disorder scale (GAD‐7).ResultsAmong 273 subjects, prevalence of WCE was 52%, 32.6% and 30.4%, according to physician and nurse BP measurements, respectively (p = 0.000). Prevalence of WCE did not differ between patients diagnosed with and without dementia, but was higher among patients with than in those without anxiety disorder (70.7% vs 38.2%, p = 0.000). Positive relations were observed between severity of anxiety and insight of disease, which were both inversely related with severity of coginitive impairment.ConclusionsWCE is extremely common and is correlated to individual anxiety and insight of disease among older outpatients with suspected cognitive impairment; overestimation of hypertension severity might lead to unnecessary drug treatment and greater health costs in this setting. Copyright © 2008 John Wiley & Sons, Ltd.

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“…Subjects usually attending at the Lipid Clinic include mainly patients with dyslipidemia (regardless of its nature and severity) with multiple risk factors and/or with history of previous cardiovascular events, mostly referred to the centre by their general practitioners [19].…”

Section: Methodsmentioning

confidence: 99%

“…Blood samples were collected from an antecubital vein into vacutainer tubes containing EDTA after a 12-hour overnight fast for the measurement of baseline routine measurements (complete blood cell count, glucose, creatinine, liver enzymes, total bilirubin, total protein, albumin, immunoglobulin, thyroid stimulating hormone, creatine-kinase, uric acid), plasma lipid and lipoprotein levels, inflammatory markers (fibrinogen and hs-CRP), insulin and homocysteine, according to standardized procedures which have been described elsewhere [19] and [21].…”

Section: Biochemical Analysismentioning

confidence: 99%

Implications of routinely measuring Ankle-Brachial Index (ABI) among patients attending at a Lipid Clinic

Sona

Comba

Brescianini

et al. 2009

European Journal of Internal Medicine

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The definitive versionisavailableat:La versione definitiva è disponibile alla URL: [http://www.sciencedirect.com/science/article/pii/S0953620508002677?via=ihub] Implications of routinely measuring Ankle-Brachial Index (ABI) among patients attending at a Lipid Clinic Alessandro Sona, Monica Comba, Alessia Brescianini, Laura Corsinovi, Mauro Zanocchi, Gianfranco Fonte, Mario BoCorresponding author contact information, E-mail the corresponding author Abstract BackgroundLow (≤ 0.90) Ankle Brachial Index (ABI) values identify patients at high risk for cardiovascular (CV) disease and mortality. Implications for CV risk classification from routinely measuring ABI in the context of a Lipid Clinic have not been fully investigated. We aimed to evaluate whether and to what extent routine ABI determination on top of conventional risk prediction models may modify CV risk classification. MethodsConsecutive asymptomatic non-diabetic individuals free from previous CV events attending for a first visit at a Lipid Clinic underwent routine ABI determination and conventional CV risk classification according either to national CUORE model (including age, gender, smoking, total and high density lipoprotein cholesterol, systolic blood pressure and current use of blood pressure lowering drugs) and SCORE model for low risk countries. ResultsIn the overall sample (320 subjects, mean age 64.8 years) 77 subjects (24.1%) were found to have low ABI value. Forty-two of 250 subjects (16.8%) and 47 of 215 individuals (21.3%) at low or moderate risk according to the CUORE and SCORE models, respectively, were found to have low ABI values, and should be reclassified at high risk. ConclusionIn a series of consecutive asymptomatic individuals in a Lipid Clinic, we observed a high prevalence of low ABI values among subjects deemed at low or moderate risk on conventional prediction models, leading to CV high-risk reclassification of roughly one fifth of patients. These findings reinforce recommendations for routine determination of ABI at least within referral primary prevention settings.

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

Cited by 7 publications

References 26 publications

Doctors record higher blood pressures than nurses: systematic review and meta-analysis

Doctors record higher blood pressures than nurses: systematic review and meta-analysis

White‐coat effect among older patients with suspected cognitive impairment: prevalence and clinical implications

Implications of routinely measuring Ankle-Brachial Index (ABI) among patients attending at a Lipid Clinic

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