title: Are there consequences of labeling patients with prehypertension? An experimental study of effects on blood pressure and quality of life.
abstract: OBJECTIVE
  The prehypertension classification was introduced to facilitate prevention efforts among patients at increased risk for hypertension. Although patients who have been told that they have hypertension report worse outcomes than unaware hypertensives, little is known about whether or not prehypertension labeling has negative effects. We evaluated the effects of labeling individuals with prehypertension on blood pressure and health-related quality of life three months later.
  
  
  METHODS
  One hundred adults (aged 19 to 82 [mean=40.0] years; 54% women; 64% racial/ethnic minorities) with screening blood pressure in the prehypertensive range (120-139/80-89 mmHg) and no history of diagnosis or treatment of elevated blood pressure were randomly assigned to either a "Labeled" group in which they were informed of their prehypertension, or an "Unlabeled" group in which they were not informed. Subjects underwent office blood pressure measurement, 24-hour ambulatory blood pressure monitoring and completed self-report questionnaires at baseline and at three months.
  
  
  RESULTS
  Multilevel mixed effects regression analyses indicated that changes in the white coat effect, office blood pressure, mean daytime ambulatory blood pressure, and physical and mental health did not differ significantly between the two groups. Adjusting for age, sex, race/ethnicity and body mass index did not affect the results.
  
  
  CONCLUSIONS
  These findings suggest that labeling patients with prehypertension does not have negative effects on blood pressure or quality of life. Additional research is needed to develop approaches to communicating with patients about their blood pressure that will maximize the clinical and public health impact of the prehypertension classification.
authors.affiliation: Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, USA. tanya.spruill@nyumc.org
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Spruill
authors.forename: Seth D
authors.initials: SD
authors.lastname: Feltheimer
authors.forename: Manjunath
authors.initials: M
authors.lastname: Harlapur
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.forename: Youngjun
authors.initials: Y
authors.lastname: Park
authors.forename: William
authors.initials: W
authors.lastname: Gerin
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D001364:Awareness; D001794:Blood Pressure; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D058246:Prehypertension / Q000175:diagnosis* / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D059466:White Coat Hypertension / Q000175:diagnosis / Q000523:psychology*