PT  - JOURNAL ARTICLE
AU  - Augustovski, Federico A.
AU  - Calvo, Cecilia B.
AU  - Deprati, Matı́as
AU  - Waisman, Gabriel
TI  - The Deep-Breath Test as a Diagnostic Maneuver for White-Coat Effect in Hypertensive Patients
AID  - 10.3122/jabfm.17.3.184
DP  - 2004 May 01
TA  - The Journal of the American Board of Family Practice
PG  - 184--189
VI  - 17
IP  - 3
4099  - http://www.jabfm.org/content/17/3/184.short
4100  - http://www.jabfm.org/content/17/3/184.full
SO  - J Am Board Fam Med2004 May 01; 17
AB  - Background: The white-coat effect is a common phenomenon in hypertensive patients, and there is no current useful office test to detect it.Methods: This was a cross-sectional study. We evaluated the deep-breath maneuver at the office as a diagnostic test of the white-coat effect. Participants included 83 adult patients with uncontrolled office hypertension. We measured sensitivity, specificity, likelihood ratios of different cutoff points, area under receiver operating characteristic (ROC) curve, and 95% confidence intervals. The reference standard used was 24-hour ambulatory blood pressure monitoring.Results: We included 73 patients [mean age, 58.7 ± 9.5 years (mean ± SD); 55% women]. The prevalence of white-coat effect was 62%. Comparing patients with white-coat effect versus those without, the deep-breath test resulted in a mean systolic blood pressure decrease of 17.8 and 10.9 mm Hg (P < .001) and a mean diastolic decrease of 6.6 and 5.4 mm Hg, respectively (P = not significant). The area under the ROC curve of systolic blood pressure change was 0.69 (95% confidence interval, 0.57 to 0.81). Interobserver agreement was very good.Conclusions: The deep-breath test can be a helpful maneuver for the detection of white-coat effect. It has no major adverse effects and it may help avoid overtreatment and unnecessary further testing procedures.