Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, USA.
Am J Hypertens. 2012 Apr;25(4):458-63. doi: 10.1038/ajh.2011.258. Epub 2012 Jan 19.
Blood pressure screening is an important component of cardiovascular disease prevention, but a hypertension diagnosis (i.e., label) can have unintended negative effects on patients' well-being. Despite persistent disparities in hypertension prevalence and outcomes, whether the impact of labeling differs by race is unknown. The purpose of this study was to evaluate possible race differences in the relationship between hypertension labeling and health-related quality of life and depression.
The sample included 308 normotensive and unmedicated hypertensive subjects from the Neighborhood Study of Blood Pressure and Sleep, a cross-sectional study conducted between 1999 and 2003. Labeled hypertension was defined (by self-report) as having been diagnosed with high blood pressure or prescribed antihypertensive medications. Effects of labeling and race on self-reported physical and mental health and depressive symptoms were tested using multivariate analysis of covariance, controlling for age, sex, body mass index (BMI), previous medication use, and "true" hypertension status, defined by average daytime ambulatory blood pressure (ABP).
Both black and white subjects who had been labeled as hypertensive reported similarly poorer physical health than unlabeled subjects (P = 0.001). However, labeling was associated with poorer mental health and greater depressive symptoms only among blacks (Ps < 0.05 for the interactions). These findings were not explained by differences in socioeconomic status.
These results are consistent with previous studies showing negative effects of hypertension labeling, and demonstrate important race differences in these effects. Clinical approaches to communicating diagnostic information that avoid negative effects on well-being are needed, and may require tailoring to patient characteristics such as race.
血压筛查是心血管疾病预防的重要组成部分，但高血压诊断（即标签）可能会对患者的健康产生意想不到的负面影响。尽管高血压的患病率和结果存在持续的差异，但标签是否会因种族而异尚不清楚。本研究的目的是评估高血压标签与健康相关的生活质量和抑郁之间的关系是否存在种族差异。
该样本包括来自血压和睡眠邻里研究的 308 名正常血压和未服药的高血压患者，这是一项在 1999 年至 2003 年期间进行的横断面研究。通过自我报告定义标签性高血压，即被诊断为高血压或服用抗高血压药物。使用多变量协方差分析测试标签和种族对自我报告的身体和心理健康以及抑郁症状的影响，控制年龄、性别、体重指数（BMI）、先前的药物使用以及“真正的”高血压状态，由日间动态血压（ABP）平均定义。
被标记为高血压的黑人和白人患者都报告说他们的身体健康状况明显不如未被标记的患者（P = 0.001）。然而，只有黑人患者的标签与心理健康状况较差和抑郁症状更严重有关（交互作用 P < 0.05）。这些发现不能用社会经济地位的差异来解释。
这些结果与之前的研究一致，表明高血压标签存在负面影响，并表明这些影响存在重要的种族差异。需要采取避免对幸福感产生负面影响的临床方法来传达诊断信息，并且可能需要根据患者的特征（如种族）进行调整。
