The deep-breath test as a diagnostic maneuver for white-coat effect in hypertensive patients

The white-coat effect is a common phenomenon in hypertensive patients, and there is no current useful office test to detect it. This was a cross-sectional study. We evaluated the deep-breath maneuver at the office as a diagnostic test of the white-coat effect. Participants included 83 adult patients...

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Bibliographic Details
Published in:	The Journal of the American Board of Family Practice Vol. 17; no. 3; pp. 184 - 189
Main Authors:	Augustovski, Federico A, Calvo, Cecilia B, Deprati, Matías, Waisman, Gabriel
Format:	Journal Article
Language:	English
Published:	United States 01-05-2004
Subjects:	Blood Pressure Determination - methods Cross-Sectional Studies Diagnostic Errors - prevention & control Female Humans Hypertension - diagnosis Male Middle Aged Observer Variation ROC Curve Sensitivity and Specificity
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Summary:	The white-coat effect is a common phenomenon in hypertensive patients, and there is no current useful office test to detect it. This was a cross-sectional study. We evaluated the deep-breath maneuver at the office as a diagnostic test of the white-coat effect. Participants included 83 adult patients with uncontrolled office hypertension. We measured sensitivity, specificity, likelihood ratios of different cutoff points, area under receiver operating characteristic (ROC) curve, and 95% confidence intervals. The reference standard used was 24-hour ambulatory blood pressure monitoring. We included 73 patients [mean age, 58.7 +/- 9.5 years (mean +/- SD); 55% women]. The prevalence of white-coat effect was 62%. Comparing patients with white-coat effect versus those without, the deep-breath test resulted in a mean systolic blood pressure decrease of 17.8 and 10.9 mm Hg (P <.001) and a mean diastolic decrease of 6.6 and 5.4 mm Hg, respectively (P = not significant). The area under the ROC curve of systolic blood pressure change was 0.69 (95% confidence interval, 0.57 to 0.81). Interobserver agreement was very good. The deep-breath test can be a helpful maneuver for the detection of white-coat effect. It has no major adverse effects and it may help avoid overtreatment and unnecessary further testing procedures.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0893-8652
DOI:	10.3122/jabfm.17.3.184