Deep breathing: A simple test for white coat effect detection in primary care

Tomičić, Marion; Petric, Dragomir; Rumboldt, Mirjana; Carević, Vedran; Rumboldt, Zvonko

doi:10.3109/08037051.2014.997102

Cited by 6 publications

(2 citation statements)

References 20 publications

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“…A deep breathing test might be used as another strategy to target or minimize the usage of outside BP monitoring. In a clinical study, patients are unlikely to have WCHTN identified using ABPM if their systolic BP fell by 15% or less following 30 seconds of deep breathing [ 141 ].…”

Section: Reviewmentioning

confidence: 99%

Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect

Habas,

Akbar,

Alfitori

et al. 2023

Cureus

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Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep. It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression. A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.

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Section: Reviewmentioning

confidence: 99%

Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect

Habas,

Akbar,

Alfitori

et al. 2023

Cureus

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“…In the Federico et al study, the DBT resulted in a statistically significant difference in mean SBP drop of 17.8 and 10.9 mmHg ( p < 0.001) among patients with or without white-coat effect respectively [29]. In the Marion et al study, a 15% drop in SBP was found to be corresponded to a 96% specificity (95% CI 79.0–100.0) and 94% positive predictive value (95% CI 72.0–100.0) in the diagnosis of white-coat hypertension [30]. The Jose et al study evaluated the diagnostic accuracy of DBT on identifying white-coat hypertension.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the applicability of deep breathing test in the diagnosis of hypertension with white-coat effect in Chinese patients in primary care

Chan¹,

Lai²,

Chan³

et al. 2019

Clin Hypertens

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PurposeThe current gold standard for the diagnosis of white-coat effect is by the 24-h ambulatory blood pressure monitoring (ABPM) which may not be readily available in every primary care setting. Previous studies had shown that deep breathing, through modulating the baroreceptor reflex sensitivity to vagal stimulation over 30 to 60 s, was useful in detection of the white-coat effect. The aim of our study was to evaluate the diagnostic accuracy of the deep breathing test (DBT) as compared with the gold standard of ABPM in the diagnosis of hypertension with white-coat effect in Chinese patients in primary care.MethodsThis cross sectional study recruited 178 consecutive, eligible, consented, hypertensive patients receiving treatment at a local public primary care Hypertension Clinic.The diagnostic accuracy of the DBT in all recruited patients, patients not taking beta-adrenergic blockers and patients with different clinic SBP cut-off before the DBT by means of area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values was evaluated.ResultsThe results for the ROC curves for systolic and diastolic BP changes after the DBT were statistically insignificant. The ROC curve was statistically significant for SBP change in patients not taking beta-adrenergic blockers and with pre-DBT clinic SBP ≥ 165 mmHg (ROC curve area of 0.719, 95% CI 0.53 to 0.91, p = 0.04). The corresponding sensitivity and specificity of the DBT were 40.9 and 90.9% respectively if SBP drop was > 30 mmHg.ConclusionThe DBT, even though could not be clinically applied to all patients, was proven to be a potential screening and diagnostic test for white-coat effect in Chinese hypertensive patients with a pre-test SBP of ≥165 mmHg and who were not taking beta-adrenergic blockers.Trial registrationThis study was approved by Kowloon East Cluster/ Kowloon Central Cluster Research Ethics Committee/Institutional Review Board of Hospital Authority of Hong Kong under the registration KC/KE-16-0084/ER-3.

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