Güler Yeliz, Genç Ömer, Yıldırım Abdullah, Halil Ufuk S, Çapar Gazi, Özdoğan Cansu G, Erdoğan Aslan, Güler Ahmet, Kırma Cevat
Department of Cardiology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye.
Department of Cardiology, Adana City Training and Research Hospital, Adana, Türkiye.
Anatol J Cardiol. 2024 Oct 30;29(1):2-10. doi: 10.14744/AnatolJCardiol.2024.4746.
To investigate the relationship between anxiety and white coat hypertension (WCH) using the hospital anxiety and depression scale-anxiety (HADS-A) score.
Participants lacking a pre-existing diagnosis of hypertension but displaying increased office blood pressure were included in this study. Subsequently, they were classified as either newly diagnosed sustained hypertension (SustHT) or white coat hypertension (WCH) patients, as determined by 24-hour ambulatory blood pressure monitoring measurements. The assessment of their anxiety levels was conducted using the HADS-A questionnaire. We performed regression, comparative, and sensitivity analyses to elucidate the association between anxiety and WCH.
In this cohort of 303 consecutive individuals (mean age 54 years, 46% female), 81 (26.7%) patients were diagnosed with WCH. Those with WCH were younger (49 vs. 56 years, P < .001), had higher heart rate (85 vs. 76 bpm, P < .001) and exhibited a female predominance (56% vs. 43%, P = .049) compared to individuals with SustHT. The HADS-A was higher in WCH than in SustHT (9.0 ± 2.9 vs. 6.6 ± 2.6, P < .001). Furthermore, HADS-A showed positive correlation with systolic and diastolic pressures measured in the out-patient clinic (r = 0.523 and r = 0.387, respectively; P < .001 for both). The full model with HADS-A had better discriminatory power (Harrell's c-index 0.82 vs. 0.77, P = .0025), increased calibration, and a greater net benefit than the base model without. The ROC curve analysis, using a cut-off of >6 for HADS-A, demonstrated a sensitivity of 76.5% and specificity of 53.6% in detecting WCH (Area Under the Curve = 0.72, P < .001).
Our study revealed that individuals with WCH, in comparison to those with SustHT, exhibit a higher level of anxiety as indicated by HADS-A.
使用医院焦虑抑郁量表-焦虑（HADS-A）评分来研究焦虑与白大衣高血压（WCH）之间的关系。
本研究纳入了既往无高血压诊断但诊室血压升高的参与者。随后，根据24小时动态血压监测结果，将他们分为新诊断的持续性高血压（SustHT）患者或白大衣高血压（WCH）患者。使用HADS-A问卷对他们的焦虑水平进行评估。我们进行了回归分析、比较分析和敏感性分析，以阐明焦虑与WCH之间的关联。
在这一连续纳入的303名个体队列中（平均年龄54岁，46%为女性），81名（26.7%）患者被诊断为WCH。与SustHT患者相比，WCH患者更年轻（49岁对56岁，P <.001），心率更高（85次/分对76次/分，P <.001），且女性占比更高（56%对43%，P =.049）。WCH患者的HADS-A评分高于SustHT患者（9.0±2.9对6.6±2.6，P <.001）。此外，HADS-A与门诊测量的收缩压和舒张压呈正相关（分别为r = 0.523和r = 0.387；两者P均<.001）。与不含HADS-A的基础模型相比，包含HADS-A的完整模型具有更好的鉴别能力（Harrell氏c指数0.82对0.77，P =.0025）、更高的校准度和更大的净效益。使用HADS-A>6作为临界值的ROC曲线分析显示，检测WCH的敏感性为76.5%，特异性为53.6%（曲线下面积 = 0.72，P <.001）。
我们的研究表明，与SustHT患者相比，WCH患者的焦虑水平更高，这由HADS-A评分所示。
