Lessons from white coat hypertension: Comment on Spruill et al. "the impact of perceived hypertension status on anxiety and the white coat effect"

Abstract

The Implications of White Coat Hypertension by Spruill et al. (2007) are multiple and extend well beyond the domain of hypertension and cardiovascular risk. First, their excellent study indicates that theory and research need to treat emotional reactions as situation-specific events. Although traits such as Anxiety can be easily and reliably measured, their assessment may not detect the situation-specific mechanisms that link emotional responses to health risks. Second, patients' self perceptions, whether they label themselves as having a chronic disease, give meaning to the situational cues that elicit emotional reactions. Third, as Spruill et al. indicate, health behavioral research needs to examine how the clinical setting and social and cultural frameworks affect self-labeling. We add to their clinical concerns by questioning whether a clinician's words, i.e., whether they suggest a condition is related to stress, can in our contemporary culture, lead patients to treat a condition as acute rather than chronic, and how the clinicians' behavior, e.g., attention to specific areas of the body during a clinical examination, may shape the perceived cause of symptoms. The implications of this excellent study extend well beyond its focus on white coat hypertension. © 2007 by The Society of Behavioral Medicine.