White coat phenomenon, anxiety and endothelial function in healthy normotensive elderly subjects.
OBJECTIVE
The white coat phenomenon (WCP) is a blood pressure (BP) elevation specifically observed in the clinical setting. Though WCP has been suggested to associate with emotional responses such as anxiety or with cardiovascular complications, its pathogenesis and clinical significance are unclear. We studied the possible association between WCP and anxiety or vascular function in normotensive elderly subjects without major cardiovascular risk factors.


METHODS
As a parameter of anxiety, the State and Trait Anxiety Inventory (STAI) was used. WCP was evaluated by calculating the difference between the clinic BP and mean daytime ambulatory BP. As parameters of vascular function, brachial artery endothelium-dependent flow-mediated dilation (FMD) and the endothelium-independent dilation response to sublingual glyceryl trinitrate (GTN) were measured using high-resolution ultrasound.


RESULTS
Using confounding factors as covariates, no association was observed between WCP and the STAI-trait or STAI-state score. There was a significant negative association between WCP and the percent change of FMD but no association between WCP and the percent change of GTN.


CONCLUSIONS
WCP in the healthy normotensive elderly subjects may reflect a decrease in endothelial function, i.e. initial stage atherosclerosis, rather than anxiety.
Murata
Tetsuhito
T
Department of Neuropsychiatry, University of Fukui, Japan. tmurata@fmsrsa.fukui-med.ac.jp
Narita
Kosuke
K
Hamada
Toshihiko
T
Takahashi
Tetsuya
T
Omori
Masao
M
Yoshida
Haruyoshi
H
Wada
Yuji
Y
D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001294:Attitude to Health; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory / Q000523:psychology*; D004730:Endothelium, Vascular / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012016:Reference Values; D012044:Regression Analysis