[Influence of the sex of the physician in the alerting reaction in blood pressure determination in the elderly. EPICARDIAN Working Group].
BACKGROUND
Blood pressure measurements by a physician and to a lesser extent by a nurse often lead the patient to experience an alerting reaction associated with an increase in blood pressure. The main factor seems to be the interaction between the patient and the observer physicians, on average, record higher office blood pressure than nurses and non-physicians. There is no information about the influence of the physician's gender on alerting reaction.


OBJECTIVE
To asses the influence of gender's doctor on alerting reaction in the elderly.


METHODS
EPICARDIAN study is a cross-sectional survey of the civilian non-institutionalized elderly population in a health area, including an inhome interview (phase I, n = 1,200) and a clinical examination (phase II, a random sample n = 333). Three different blood pressure measurements were performed: conventional blood pressure was measured by trained nurses at the participant's home, and at the hospital by two physicians: a man (group A, n = 131, 46% men) and a women (group B, n = 152, 45% men). All subjects were informed by a nurse that they were going to be interviewed by a doctor. Twenty-four hour ambulatory blood pressure was recorded at 15 minute intervals, awake and sleep periods were defined based on daily activities. Alerting reaction was defined as the difference between means at home, office and awake period.


RESULTS
Office blood pressures were distinctively higher than the awake average (15 mmHg for systolic blood pressure and 7 mmHg for diastolic respectively) in 83% of subjects. Differences between clinical and awake average blood pressure were significantly higher in females than in males (17 +/- 16 and 12 +/- 16 respectively, p < 0.0001) and increased, in both sexes with increasing age (p = 0.001) and clinic blood pressure values (p < 0.001). There were no sex, age, body mass index, casual home blood pressure and awake blood pressure period differences between groups A and B. Group A, interviewed by a man, showed an average of 10 mmHg more than group B, interviewed by a woman, on office alerting reaction (22 +/- 18/11 +/- 11 mmHg versus 12 +/- 16/3.6 +/- 10 mmHg systolic blood pressure/diastolic blood pressure alerting reaction, respectively p < 0.001 in both cases). Differences were similar when analizying men and women independently.


CONCLUSIONS
Alerting reaction during blood pressure measurement in the elderly is higher when the observer is a male physician than when the physician is a female, independent of the patient's gender.
del Arco Galán
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Unidad de Hipertensión, Hospital de La Princesa, Madrid.
Suárez Fernández
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D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000523:psychology*; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000523:psychology; D008297:Male; D010820:Physicians; D010822:Physicians, Women; D012737:Sex Factors