IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311359
Open Access Original Research
The Influence of Factors such as Anxiety on the White Coat Effect during the Treatment of Patients with Hypertension
Dengyue Xu1,2,†Hengxia Qiu2,†Ze Li3,†Peishi Yan2He Xu2Yu Gu2,*Hailong Lin4,*
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1 Postgraduate College, China Medical University, 110122 Shenyang, Liaoning, China
2 Department of Cardiology, Dalian Municiple Central Hospital, 116000 Dalian, Liaoning, China
3 Department of Cadre Ward, 79th Group Army Hospital of PLA Army, 111000 Liaoyang, Liaoning, China
4 Geriatrics Center, Dalian Municiple Friendship Hospital, 116000 Dalian, Liaoning, China
*Correspondence: (Hailong Lin); (Yu Gu)
These authors contributed equally.
Academic Editor: Rubattu Speranza
Rev. Cardiovasc. Med. 2022, 23(11), 359;
Submitted: 10 June 2022 | Revised: 1 September 2022 | Accepted: 5 September 2022 | Published: 25 October 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: The white coat effect is observed in many patients with hypertension, but its mechanism is still unclear and anxiety is often thought to be a key point. Methods: A total of 544 patients who met the inclusion criteria were recruited through outpatient clinics. Three months after systematic treatment, the office blood pressure and ambulatory blood pressure monitoring (ABPM) were examined. Patients who reached the ABPM standard were divided into white coat effect (n = 112) and control (n = 432) groups according to the results of the office blood pressure. The degree of anxiety in the two groups was evaluated using the Self-rating Anxiety Scale (SAS) and the Beck Anxiety Scale (BAI). Differences in anxiety, gender, age, number of antihypertensive drugs, cost per tablet and marital status were analyzed. Results: There was no significant difference in the degree of anxiety between the white coat and control groups, with mean SAS standard scores of 32.8 ± 8.5 vs. 31.8 ± 9.9, respectively (p = 0.170). Similarly, the mean BAI standard scores were 31.4 ± 8.3 vs. 31.2 ± 9.5, respectively (p = 0.119). Logistic regression analysis showed that the factors of female gender (β = –1.230, p < 0.001), old age (β = 0.216, p < 0.001), number of antihypertensive drugs (β = 1.957, p < 0.001), and cost per tablet (β = 1.340, p < 0.001) were significantly related to the white coat effect. Conclusions: Anxiety was not necessary for the white coat effect in hypertension patients during treatment. Female gender, old age, number of antihypertensive drugs used and cost per tablet were related to the white coat effect in hypertension patients during treatment.

white coat effect
Self-Rating Anxiety Scale
Beck Anxiety Inventory
blood pressure
81970310/National Natural Science Foundation of China
82070239/National Natural Science Foundation of China
82170328/National Natural Science Foundation of China
2020-MS-036/Natural Science Foundation of Liaoning Province
18-JCJQ-QT-018/Young Talent Fund of Military Science and Technology Project
Fig. 1.
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