Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey.
University of Health Sciences, Adana City Training and Research Hospital, Department of Cardiology, Adana, Turkey.
J Hum Hypertens. 2024 Jul;38(7):561-567. doi: 10.1038/s41371-024-00920-7. Epub 2024 Jun 6.
The relationship between white coat hypertension (WCH) and anxiety remains not fully elucidated. This study aims to investigate the correlation between WCH and Templer's Death Anxiety Scale (T-DAS) questionnaire. Asymptomatic individuals with a familial history of sudden cardiac death or acute myocardial infarction within the last year, who presented at our cardiology outpatient clinic, were enrolled in this prospective, single-center, cross-sectional study. Among those with elevated blood pressure in the outpatient clinic setting, participants were categorized into normotensive and WCH groups through 24-hour ambulatory blood pressure monitoring. Demographic features, laboratory parameters, and T-DAS scores were documented. Logistic regression and sensitivity analyses were conducted to ascertain WCH occurrence. Among 324 consecutive participants, 90 were diagnosed with WCH. T-DAS scores were significantly elevated in the WCH subgroup, particularly among those seeking early medical attention following bereavement. Multivariable logistic regression highlighted gender, BMI, heart rate, T-DAS, and admission time as independent correlates of WCH. Significantly, T-DAS exhibited the third most substantial contribution to the regression analysis, following admission time and heart rate. The multivariable logistic regression analysis incorporating T-DAS exhibited high robustness, discrimination, fit, and calibration, with a Brier score of 0.106, adjusted R of 0.576, and C-statistic of 0.905 (95% CI: 0.871-0.940, p < 0.001). T-DAS, with a threshold of >8, demonstrated 48% sensitivity and 90% specificity in detecting WCH. Additionally, decision curve analysis verified that the model including T-DAS offers a net benefit in detecting WCH. This study unveils a potential association between WCH and death anxiety.
白大衣高血压(WCH)与焦虑之间的关系尚未完全阐明。本研究旨在探讨 WCH 与 Templer 死亡焦虑量表(T-DAS)问卷之间的相关性。本前瞻性、单中心、横断面研究纳入了在我们心内科门诊就诊的、有家族性心源性猝死或急性心肌梗死病史且无症状的个体。在门诊就诊时血压升高的患者中,通过 24 小时动态血压监测将患者分为血压正常和 WCH 组。记录了人口统计学特征、实验室参数和 T-DAS 评分。进行了逻辑回归和敏感性分析以确定 WCH 的发生情况。在 324 名连续参与者中,有 90 名被诊断为 WCH。WCH 亚组的 T-DAS 评分显著升高,尤其是在丧亲后寻求早期医疗关注的患者中。多变量逻辑回归强调了性别、BMI、心率、T-DAS 和入院时间是 WCH 的独立相关因素。重要的是,T-DAS 对回归分析的贡献仅次于入院时间和心率,位列第三。包含 T-DAS 的多变量逻辑回归分析具有较高的稳健性、区分度、拟合度和校准度,Brier 评分为 0.106,调整 R 为 0.576,C 统计量为 0.905(95%CI:0.871-0.940,p<0.001)。T-DAS 阈值>8 时,检测 WCH 的敏感性为 48%,特异性为 90%。此外,决策曲线分析证实,包含 T-DAS 的模型在检测 WCH 方面具有净收益。本研究揭示了 WCH 与死亡焦虑之间的潜在关联。