title: The deep-breath test as a diagnostic maneuver for white-coat effect in hypertensive patients.
abstract: BACKGROUND
  The white-coat effect is a common phenomenon in hypertensive patients, and there is no current useful office test to detect it.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unidad de Medicina Familiar y Preventiva, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. faugus@post.harvard.edu
authors.forename: Federico A
authors.initials: FA
authors.lastname: Augustovski
authors.forename: Cecilia B
authors.initials: CB
authors.lastname: Calvo
authors.forename: Matías
authors.initials: M
authors.lastname: Deprati
authors.forename: Gabriel
authors.initials: G
authors.lastname: Waisman
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods*; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012680:Sensitivity and Specificity