Association of Anxiety with Discrepancies Between Unattended and Attended Office Blood Pressure Measurement

Abstract BACKGROUND Precision of blood pressure (BP) measurements is crucial in hypertension care. Conventional office measurements (OBP) are susceptible to confounding factors, including the white coat effect. An emerging alternative is unattended automated office BP measurement (UAOBP). UAOBP values are typically lower than OBP, but factors responsible for this phenomenon remain poorly understood. The study aimed to analyze factors affecting discrepancies between these methods. METHODS Two hundred and nineteen hypertensive patients completed the State-Trait Anxiety Inventory questionnaire, assessing anxiety levels. Subsequently, BP measurements were performed using two methodologies in a randomized sequence: UAOBP: After a 5-minute rest in the examination room, BP was automatically measured three times at 1-minute intervals. OBP: Following a 5-minute rest, a physician performed three automated oscillometric measurements at 1-minute intervals. RESULTS The BP values obtained through UAOBP were significantly lower than those in OBP: mean (SD) 124.7 (14.4) vs. 128.2 (14.2) mmHg, P < 0.001 for systolic, and 73.3 (10.2) vs. 75.2 (10.6) mmHg, P < 0.001 for diastolic. In the multiple regression analysis, the only factors significantly affecting the differences in systolic BP measurements were trait anxiety level (β = 0.22; P = 0.02) and the order in which the measurements were taken (β = 3.5; P = 0.01). Diastolic BP differences were only predicted by the order of measurement (β = 2.8; P < 0.001). CONCLUSIONS UAOBP appears particularly efficient in mitigating the white coat effect in patients with high levels of anxiety. Further research is needed to investigate whether this may improve the assessment of BP-related risk in such patients.