Hypertensive labeling: does it have therapeutic implications.

Screening for hypertension within the proper setting potentially leads to the detection of numerous (mild) hypertensives, some of whom in due time may well qualify for treatment. One disadvantage of the procedure appears to be that hitherto unwitting hypertensives may develop some adverse psychological and physiological phenomena. Behavioral effects seem to be particularly obvious after screening on the worksite, where newly identified hypertensive employees tend to respond with increased absenteeism and allied symptoms of labeling. In the clinical setting, physiological studies in recently informed hypertensives have demonstrated a series of signs of increased sympathetic activity: heart rate, cardiac index, circulating catecholamines, and renin, and even blood pressure itself, tend to be higher in aware vs. unaware young hypertensives. Although some correlations between psychological and physiological sequelae have been observed, the true nature of such links is far from clear. Simple anxiety does not seem to be the main mechanism. Pending further research, the question is discussed as to whether these phenomena are harmful enough to warrant a need for counseling or treatment.