Effects of Labeling Patients as Prehypertensive

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Figure 1.
Participant flow-through study. BP, blood pressure.

Table 1.

Characteristics of Enrolled Participants

	Overall (n) (n = 97)	No Label Group (n [%]) (n = 47)	Label Group (n [%]) (n = 50)	P
Age category (years)				.27
24–39	49	21 (45)	28 (56)
≥40	48	26 (55)	22 (44)
Female sex	43	20 (43)	23 (46)	.73
Race				.26
White	36	18 (38)	18 (36)
Black	49	22 (47)	27 (54)
Other	12	7 (16)	5 (10)
Hispanic ethnicity	10	7 (15)	3 (6)	.15
Education level				.42
<High school	11	7 (15)	4 (8)
High school graduate	9	6 (13)	3 (6)
Some college	33	15 (32)	18 (36)
College graduate	44	19 (40)	25 (50)
Self-reported health				.19
Excellent	19	5 (11)	14 (28)
Very good	41	23 (49)	18 (36)
Good	33	17 (36)	16 (32)
Fair	4	2 (4)	2 (4)
Poor	0	0	0
Married or living with partner	48	24 (51)	24 (48)	.84
Current smoker	28	13 (28)	15 (30)	.80
Medical problems^*
Anxiety	9	7 (15)	2 (4)	.09
Asthma	8	1 (2)	7 (14)	.06
Arthritis or chronic pain	9	5 (11)	4 (8)	.74
Cancer	1	1 (2)	0 (0)	.49
Depression	16	8 (17)	8 (16)	1.0
Heartburn	7	2 (4)	5 (10)	.44
High cholesterol	11	6 (13)	5 (10)	.76
Migraines	6	2 (4)	4 (8)	.68
Thyroid disorder	3	1 (2)	2 (4)	1.0
None of the above	23	11 (23)	12 (24)	1.0
Average systolic BP (mm Hg)	129.0	128.6	129.4	.57^†
Average diastolic BP (mm Hg)	81.9	81.7	82.1	.75^†

BP, blood pressure.
* P for differences in medical problems by Fisher's exact test; all others by χ² test unless otherwise noted.
† P calculated by t test.

Table 2.

Characteristics of Nonrespondents and Respondents

	Nonrespondents (n = 27)	Respondents (n = 70)	P
Age category (years)			.54
24–39	15 (56)	34 (49)
≥40	12 (44)	36 (51)
Female sex	9 (33)	34 (49)	.18
Race
White	4 (15)	32 (46)	.002
Black	16 (59)	33 (47)
Other	7 (26)	3 (4)
Hispanic ethnicity	7 (26)	3 (4)	.002
Education level			.03
<High school	7 (26)	4 (6)
High school graduate	3 (11)	6 (9)
Some college	9 (33)	24 (34)
College graduate	8 (30)	36 (51)
Self-reported health			.46
Excellent	3 (11)	16 (23)
Very good	11 (41)	30 (43)
Good	12 (44)	21 (30)
Fair	1 (4)	3 (4)
Poor	0	0
Married or living with partner	11 (41)	37 (53)	.25
Current smoker	14 (52)	14 (20)	.002
Medical problems^*
Anxiety	2 (7)	7 (10)	1.0
Asthma	2 (7)	6 (9)	1.0
Arthritis or chronic pain	1 (4)	8 (11)	.44
Cancer	0	1 (1)	1.0
Depression	5 (19)	11 (16)	.77
Heartburn	2 (7)	5 (7)	1.0
High cholesterol	1 (4)	10 (14)	.28
Migraines	0	6 (9)	.18
Thyroid disorder	0	3 (4)	.56
None of the above	9 (33)	14 (20)	.19
Average systolic BP (mm Hg)	129.2	128.9	.84^†
Average diastolic BP (mm Hg)	82.8	81.6	.36^†

Values provided as n (%). BP, blood pressure.
* P for differences in medical problems by Fisher's exact test; all others by χ² test unless otherwise noted.
† P calculated by t test.

Table 3.

Reported Health at 3 Months

	All respondents (n = 70)	No label group (n = 32)	Label group (n = 38)	P^*
Compared to baseline				.78
Better	29 (41.4)	13 (40.6)	16 (42.1)
Same	40 (57.1)	18 (56.3)	22 (57.9)
Worse	1 (1.4)	1 (3.1)	0
Overall self-reported health				.30
Excellent	14 (20.0)	4 (12.5)	10 (26.3)
Very good	28 (40.0)	14 (43.8)	14 (36.8)
Good	22 (31.4)	11 (34.4)	11 (29.0)
Fair	6 (8.6)	3 (9.4)	3 (7.9)
Poor	0	0	0

Table 4.

Reported Health Behaviors at 3 Months

	All Respondents (%)	No Label Group (%)	Label Group (%)	Risk Ratio	95% CI
Changing eating habits^*	83.8	81.3	86.1	1.06	0.86–1.31
Cutting down on salt	90.0	90.6	89.5	0.99	0.84–1.15
Reducing alcohol intake^†	65.9	59.1	72.7	1.23	0.80–1.90
Exercising	78.6	71.9	84.2	1.17	0.91–1.51

Appendix 3.

Sample Size Calculations

Scenario	Group	Proportions					π^*	n	n₁ = n₂
Scenario	Group	Much Worse	Somewhat Worse	About the Same	Somewhat Better	Much Better	π^*	n	n₁ = n₂
1	No Label	0	0	0.7	0.25	0.05	0.67	58	29
	Label	0.1	0.1	0.7	0.1	0
2	No Label	0	0.05	0.8	0.1	0.05	0.66	56	28
	Label	0.1	0.15	0.7	0.05	0
3	No Label	0	0	0.9	0.1	0	0.64	52	26
	Label	0.1	0.1	0.8	0	0

* Pr(no label > label) + 0.5 × Pr(no label = label) = competing probability that a nonlabeled individual has a better outcome than a labeled individual.