title: Predictors of the community pharmacy white-coat effect in treated hypertensive patients. The MEPAFAR study.
abstract: OBJECTIVE
  To determine whether age, gender, body mass index (BMI), community pharmacy blood pressure (CPBP), daytime ambulatory BP (ABP) variability, treatment compliance, number of anti-hypertensive drugs and smoking status are factors associated with the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients.
  
  
  METHODS
  Eight community pharmacies in Gran Canaria, Spain.
  
  
  METHODS
  A cross-sectional study was carried out from June 2008 to June 2009. The study included treated hypertensive patients older than 18 years. Patients were excluded if: systolic BP (SBP)/diastolic BP (DBP) ≥ 200/110 mmHg, not-recommended or unable to perform home BP measurements, changes in anti-hypertensive treatment <4 weeks, history of cardiovascular disease <6 months or pregnancy. Blood pressure (BP) was measured by a community pharmacist at 4 visits to the community pharmacy and using ABP monitoring (24 h).
  
  
  METHODS
  The CPWCE was calculated as the difference between the mean BP in the community pharmacy and daytime ABP. Independent predictors of the CPWCE were identified using multivariate linear regression analysis.
  
  
  RESULTS
  Two hundred thirteen patients agreed to participate in the study. After exclusion and withdrawal, 169 patients were included in the analysis. Multiple linear regression analysis for systolic CPWCE revealed only community pharmacy SBP as an independent factor (β = 0.35; P < 0.001). The regression analysis for diastolic CPWCE revealed female gender (β = 4.88; P < 0.001), BMI (β = 0.48; P < 0.001) and community pharmacy DBP (β = 0.24; P < 0.001) as independent determinants.
  
  
  CONCLUSIONS
  In this sample of treated hypertensive patients, factors such as gender, community pharmacy DBP and BMI were positively associated and may exert an important influence on the magnitude of the diastolic CPWCE. On the other hand, the CPWCE on SBP increased as the community pharmacy SBP increased.
authors.affiliation: Pharmaceutical Care Research Group, University of Granada, Campus Universitario de Cartuja S/N, 18071 Granada, Spain. dsabater@gmail.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Sabater-Hernández
authors.forename: Pablo
authors.initials: P
authors.lastname: Sánchez-Villegas
authors.forename: José P
authors.initials: JP
authors.lastname: García-Corpas
authors.forename: Pedro
authors.initials: P
authors.lastname: Amariles
authors.forename: José
authors.initials: J
authors.lastname: Sendra-Lillo
authors.forename: María J
authors.initials: MJ
authors.lastname: Faus
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination / Q000379:methods / Q000523:psychology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000523:psychology; D003157:Community Pharmacy Services; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011369:Professional-Patient Relations
chemical_list: D000959:Antihypertensive Agents