Diagnostic Labeling: Effect on White Coat Hypertension

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DESCRIPTION (provided by applicant): The proposed career development award will enable Dr. Tanya Goyal to become an independent scientist with expertise in behavioral and psychological interventions for hypertension and cardiovascular disease. The applicant is a licensed clinical psychologist with experience in cardiovascular research. However, she has limited experience in the conduct of clinical trials with hypertensive patients and lacks some fundamental skills that are necessary for an independent research career; these skills are the focus of her short-term goals. A multidisciplinary team of mentors at Columbia University Medical Center, including Drs. Gerin, Pickering, Sloan, and Schwartz will provide training in: (1) randomized controlled trial design and analysis; (2) cardiovascular psychophysiology; (3) epidemiology; and (4) medical research dissemination. The career development plan also includes completion of a Master's degree in Biostatistics at the Columbia University Mailman School of Public Health. The applicant will conduct a research project to study the effects of diagnostic labeling on clinic blood pressure and white coat hypertension. Previous research has shown that a diagnosis (i.e., label) of hypertension is associated with subsequent increases in resting blood pressure, and preliminary work by the applicant has demonstrated a cross-sectional association between hypertension labeling and the white coat effect. The white coat effect may be particularly problematic in prehypertensives, because a small elevation in clinic blood pressure could result in crossing the diagnostic cutoff for hypertension, potentially leading to misdiagnosis and unnecessary treatment. The proposed study will examine effects of prehypertension labeling on clinic and ambulatory blood pressure, and will examine potential psychological mediators of these associations. Participants will be 100 newly identified prehypertensives who have never been labeled. They will be randomly assigned to two groups which are given different types of feedback about their initial blood pressure screening results, and will be followed for three months. This study will provide a foundation for the development of interventions targeting the manner of delivery of diagnostic information by physicians to patients. The long-term goal of this research is to develop strategies to reduce negative psychological and physiological consequences of labeling, and thus to improve the accuracy of diagnosis. (End of Abstract)