Advertisement

Predictors of the community pharmacy white-coat effect in treated hypertensive patients. The MEPAFAR study

  • Daniel Sabater-HernándezEmail author
  • Pablo Sánchez-Villegas
  • José P. García-Corpas
  • Pedro Amariles
  • José Sendra-Lillo
  • María J. Faus
Research Article

Abstract

Objective: To determine whether age, gender, body mass index (BMI), community pharmacy blood pressure (CPBP), daytime ambulatory BP (ABP) variability, treatment compliance, number of anti-hypertensive drugs and smoking status are factors associated with the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients. Setting: Eight community pharmacies in Gran Canaria, Spain. Method: A cross-sectional study was carried out from June 2008 to June 2009. The study included treated hypertensive patients older than 18 years. Patients were excluded if: systolic BP (SBP)/diastolic BP (DBP) ≥200/110 mmHg, not-recommended or unable to perform home BP measurements, changes in anti-hypertensive treatment <4 weeks, history of cardiovascular disease <6 months or pregnancy. Blood pressure (BP) was measured by a community pharmacist at 4 visits to the community pharmacy and using ABP monitoring (24 h). Main outcome measure: The CPWCE was calculated as the difference between the mean BP in the community pharmacy and daytime ABP. Independent predictors of the CPWCE were identified using multivariate linear regression analysis. Results: Two hundred thirteen patients agreed to participate in the study. After exclusion and withdrawal, 169 patients were included in the analysis. Multiple linear regression analysis for systolic CPWCE revealed only community pharmacy SBP as an independent factor (β = 0.35; P < 0.001). The regression analysis for diastolic CPWCE revealed female gender (β = 4.88; P < 0.001), BMI (β = 0.48; P < 0.001) and community pharmacy DBP (β = 0.24; P < 0.001) as independent determinants. Conclusion: In this sample of treated hypertensive patients, factors such as gender, community pharmacy DBP and BMI were positively associated and may exert an important influence on the magnitude of the diastolic CPWCE. On the other hand, the CPWCE on SBP increased as the community pharmacy SBP increased.

Keywords

Blood pressure determination Blood pressure monitoring Community pharmacy services Hypertension Pharmacy Spain White coat effect 

Notes

Acknowledgments

To LACER laboratories, for their valuable collaboration by lending us the devices that allowed the ambulatory blood pressure monitoring and, to Eleonora Feletto, for assistance in editing the text.

Funding

None.

Conflicts of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Pickering TG, Gerin W, Schwartz AR. What is the white-coat effect and how should it be measured? Blood Press Monit. 2002;7:293–300.PubMedCrossRefGoogle Scholar
  2. 2.
    Parati G, Bilo G, Mancia G. Blood pressure measurement in research and in clinical practice: recent evidence. Curr Opin Nephrol Hypertens. 2004;13:343–57.PubMedCrossRefGoogle Scholar
  3. 3.
    Mario B, Massimiliano M, Chiara M, Alessandro S, Antonella C, Gianfranco F. White-coat effect among older patients with suspected cognitive impairment: prevalence and clinical implications. Int J Geriatr Psychiatry. 2009;24:509–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Sabater-Hernández D, Fikri-Benbrahim O, Faus MJ. Usefulness of ambulatory blood pressure monitoring for clinical decisions making. Med Clin (Barc). 2010;135:23–9.CrossRefGoogle Scholar
  5. 5.
    Lindbaek M, Sandvik E, Liodden K, Mjell J, Ravnsborg-Gjertsen K. Predictors for the white coat effect in general practice patients with suspected and treated hypertension. Br J Gen Pract. 2003;53:790–3.PubMedGoogle Scholar
  6. 6.
    Den Hond E, Celis H, Vandenhoven G, O’Brien E, Staessen JA. Determinants of white-coat syndrome assessed by ambulatory blood pressure or self-measured home blood pressure. Blood Press Monit. 2003;8:37–40.CrossRefGoogle Scholar
  7. 7.
    Manios ED, Koroboki EA, Tsivgoulis GK, Spengos KM, Spiliopoulou IK, Brodie FG, et al. Factors influencing white-coat effect. Am J Hypertens. 2008;21:153–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Sabater-Hernández D, Azpilicueta I, Sanchez-Villegas P, Amariles P, Baena MI, Faus MJ. Clinical value of blood pressure measurement in the community pharmacy. Pharm World Sci. 2010;32:552–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Viera AJ, Cohen LW, Mitchell CM, Sloane PD. Hypertensive patients’ use of blood pressure monitors stationed in pharmacies and other locations: a cross-sectional mail survey. BMC Health Serv Res. 2008;8:216.PubMedCrossRefGoogle Scholar
  10. 10.
    Coca A, Bertomeu V, Dalfo A, Esmatjes E, Guillen F, Guerrero L, et al. Self-measurement of blood pressure. Consensus paper Spain 2007. Rev Clin Esp. 2007;207:197–208.PubMedCrossRefGoogle Scholar
  11. 11.
    Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ. 2004;328:634–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Tsuyuki R, Campbell N. 2007 CHEP-CPhA guidelines for the management of hypertension by pharmacists. Can Pharm J. 2007;140:238–9.CrossRefGoogle Scholar
  13. 13.
    Tisdale JE. Role of the pharmacist in managing hypertension in patients with diabetes. Am J Health Syst Pharm. 2006;63:1129.PubMedCrossRefGoogle Scholar
  14. 14.
    Simpson SH, Johnson JA, Biggs C, Biggs RS, Kuntz A, Semchuk W, et al. Practice-based research: lessons from community pharmacist participants. Pharmacotherapy. 2001;21:731–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Topouchian JA, El Assaad MA, Orobinskaia LV, El Feghali RN, Asmar RG. Validation of two automatic devices for self-measurement of blood pressure according to the International Protocol of the European Society of Hypertension: the Omron M6 (HEM-7001-E) and the Omron R7 (HEM 637-IT). Blood Press Monit. 2006;11:165–71.PubMedCrossRefGoogle Scholar
  16. 16.
    Altunkan S, Ilman N, Kayaturk N, Altunkan E. Validation of the Omron M6 (HEM-7001-E) upper-arm blood pressure measuring device according to the International Protocol in adults and obese adults. Blood Press Monit. 2007;12:219–25.PubMedCrossRefGoogle Scholar
  17. 17.
    Altunkan S, Iliman N, Altunkan E. Validation of the Omron M6 (HEM-7001-E) upper arm blood pressure measuring device according to the International Protocol in elderly patients. Blood Press Monit. 2008;13:117–22.PubMedCrossRefGoogle Scholar
  18. 18.
    O’Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, et al. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 2005;23:697–701.PubMedCrossRefGoogle Scholar
  19. 19.
    de la Sierra A, Gorostidi M, Marin R, Redon J, Banegas JR, Armario P, et al. Evaluation and management of hypertension in Spain. A consensus guide. Med Clin (Barc). 2008;131:104–16.CrossRefGoogle Scholar
  20. 20.
    O’Brien E, Mee F, Atkins N, O’Malley K. Accuracy of the SpaceLabs 90207 determined by the British Hypertension Society protocol. J Hypertens. 1991;9:573–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Stergiou GS, Skeva II, Baibas NM, Kalkana CB, Roussias LG, Mountokalakis TD. Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements. J Hypertens. 2000;18:1745–51.PubMedCrossRefGoogle Scholar
  22. 22.
    Rodriguez Chamorro MA, Garcia-Jimenez E, Amariles P, Rodriguez Chamorro A, Faus MJ. Review of the test used for measuring therapeutic compliance in clinical practice. Aten Primaria. 2008;40:413–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Schettini C, Bianchi M, Nieto F, Sandoya E, Senra H. Ambulatory blood pressure: normality and comparison with other measurements. Hypertension working group. Hypertension. 1999;34:818–25.PubMedGoogle Scholar
  24. 24.
    Sega R, Cesana G, Milesi C, Grassi G, Zanchetti A, Mancia G. Ambulatory and home blood pressure normality in the elderly: data from the PAMELA population. Hypertension. 1997;30:1–6.PubMedGoogle Scholar
  25. 25.
    Ohlin B, Berglund G, Rosvall M, Nilsson PM. Job strain in men, but not in women, predicts a significant rise in blood pressure after 6.5 years of follow-up. J Hypertens. 2007;25:525–31.PubMedCrossRefGoogle Scholar
  26. 26.
    Gil V, Pineda M, Martinez JL, Belda J, Santos ML, Merino J. Validity of 6 indirect methods to assess treatment compliance in arterial hypertension. Med Clin (Barc). 1994;102:532–6.Google Scholar
  27. 27.
    Marquez Contreras E, Gil Guillen V, Casado Martinez JJ, Martel Claros N, De la Figuera von Wichmann M, Martin de Pablos JL, et al. Analysis of studies published on hypertension treatment non-compliance in Spain between 1984 and 2005. Aten Primaria. 2006;38:325–32.PubMedCrossRefGoogle Scholar
  28. 28.
    La Batide-Alanore A, Chatellier G, Bobrie G, Fofol I, Plouin PF. Comparison of nurse- and physician-determined clinic blood pressure levels in patients referred to a hypertension clinic: implications for subsequent management. J Hypertens. 2000;18:391–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Parati G, Ulian L, Santucciu C, Omboni S, Mancia G. Difference between clinic and daytime blood pressure is not a measure of the white coat effect. Hypertension. 1998;31:1185–9.PubMedGoogle Scholar
  30. 30.
    Lantelme P, Milon H, Vernet M, Gayet C. Difference between office and ambulatory blood pressure or real white coat effect: does it matter in terms of prognosis? J Hypertens. 2000;18:383–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Gerin W, Ogedegbe G, Schwartz JE, Chaplin WF, Goyal T, Clemow L, et al. Assessment of the white-coat effect. J Hypertens. 2006;24:67–74.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Daniel Sabater-Hernández
    • 1
    Email author
  • Pablo Sánchez-Villegas
    • 2
  • José P. García-Corpas
    • 1
  • Pedro Amariles
    • 1
    • 3
  • José Sendra-Lillo
    • 4
  • María J. Faus
    • 1
  1. 1.Pharmaceutical Care Research GroupUniversity of GranadaGranadaSpain
  2. 2.Andalusian School of Public HealthGranadaSpain
  3. 3.Faculty of PharmacyUniversity of AntioquiaMedellinColombia
  4. 4.Community Pharmacy, PalmeraValenciaSpain

Personalised recommendations