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My original query was:
I have heard it claimed that blood pressure is influenced by the sex of
the observer: an observer of the opposite sex to the subject increases
the blood pressure.
Does anyone know of any literature which demonstrates this?
An obvious supplementary question would be: does it work with gay
subjects?
I will summarize replies to the list.
Many thanks,
Martin
I have received several interesting replies, for which much thanks. The
first below has a very promising reference.
Dear Martin,
Here is the article which may be of your interest.
Millar JA, Accioly JM.
Measurement of blood pressure may be affected by an interaction between
subject and observer based on gender.
J Hum Hypertens. 1996 Jul;10(7):449-53.
On top, here're some concerning issues other than observer's gender.
Brownley KA, Light KC, Anderson NB.
Social support and hostility interact to influence clinic, work, and
home
blood pressure in black and white men and women.
Psychophysiology. 1996 Jul;33(4):434-45.
Donner-Banzhoff N, Chan Y, Szalai JP, Hilditch J.
'Home hypertension': exploring the inverse white coat response.
Br J Gen Pract. 1998 Aug;48(433):1491-5.
Mansoor GA, McCabe EJ, White WB.
Determinants of the white-coat effect in hypertensive subjects.
J Hum Hypertens. 1996 Feb;10(2):87-92.
Mancia G. Related Articles
White coat effect. Innocuous or adverse phenomenon?
Eur Heart J. 2000 Oct;21(20):1647-8.
Hope this helps.
Regards.
Ly-mee
Ly Mee Yu <[log in to unmask]>
Dear Martin.
Perhaps your question relates to the results reported in Hypertension
1987;9:209-215 by Mancia et al that nurses measure lower blood pressures
than doctors - at the time of reporting it was probably related to
nurses being women and doctors men, most often, while most patients were
men.
Best wishes
Troels Ring, MD
Aalborg, Denmark
This is essentially a component of the 'White Coat Hypertension' (or
maybe 'silk stocking hupertension' in this case :-) phenomenon - which,
as Doug Altman will probably recall, was fairly extensively studied at
Northwick Park whilst he was there. If you have not already done it, a
literature search for 'White Coat Hypertension' might uncover some
studies which have broken down results according to the sex of the
observer (and/or 'sexual orientation') - although I cannot recall having
seen such a breakdown, and therefore can only offer general comments and
anecdotes.
There is bound to be a lot of variability. Some subjects show very
little 'White Coat Phenomenon' - i.e. their BP does not alter
appreciably when a human being measures it, so the sex of the observer
is probably irrelevant. As for those who do exhibit the phenomenon, the
assumption is that it is the 'anxiety' associated with having BP
measured that leads to a rise in BP at the time of measurement. Whilst
an appreciably degree of sexual interest/arousal occasioned by the
observer might be expected to produce, or exaggerate, such a phenomenon,
one imagines that, in some subjects, the 'distraction' of sexual
attractiveness of the observer could actually have a 'calming effect',
hence potentially _reducing_ the White Coat (or stocking!) phenomenon.
Anecdotally, in clinical practice I have certainly come across cases in
which unusually high (for the {male heterosexual} patient concerned) BPs
have been recorded whenever the measurement has been undertaken by a
particular female nurse - to the extent that nurses' shift rotas could
be accurately deduced by looking at his BP chart!
The effects on heart rate are likely to be even more apparent and
immediate than the effects on BP.
As for the supplementary question, one would obviously expect that the
direction of any 'observer gender effect' would be dependent upon the
'sexual orientation' of the subject!
I will be interested to see whether you manage to turn up any 'chapter
and verse' on these issues!
Kind Regards,
John
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I don't have any citations but do have some speculation. One of
theplaces I have taught Stat was a doctoral program in Nursing. The
scuttlebutt was that all kinds of things could influence blood
pressure. Dehydration, wrong size cuffs being the first suspects. In
fact, the discredited field of lie-detectors makes extensive use of BP.
Any sort of arousal could influence BP. Fear, anxiety, annoyance,
anger, sexual attraction, sexual repulsion, etc. At work at another
job, of six woman nurses four would get 120/80 consistently over years.
There were two nurses who always read my BP high. One was a stunning
redhead who rested my arm across her ample bosom while taking my BP.
135/90. The other was an elderly woman who did not hear well. 130/90.
One time when I was at my physician's, just before I had my BP taken, I
found a pamphlet from an animal rights terrorist group. 160/100
If a person responded with higher BP to an opposite sex person who made
an advance, how would you know if it was attraction, homophilia,
repulsion, or fear of being caught?
If a person responded with higher BP to a gay person who made an
advance, how would you know if it was homophobia or attraction?
I would suggest checking physiological psychology and nursing
newsgroups.
Dear Martin,
I remember attending a talk some years ago, where the speaker (a
Professor of medical statistics whose name escapes me - he was Scottish,
tall, well-nourished, bearded, middle-aged - any ideas?) presented a
graph that showed this effect. Alternate BP measurements had been done
on a mainly male sample by (mainly male) doctors and (mainly female)
nurses. The graph was noticeably sawtoothed. If I ever remember the
speaker's name, I'll let you know.
Regards,
Sean
Sean McGuigan
Boehringer Ingelheim
Ellesfield Avenue
Bracknell
Berkshire RG12 8YS
Phone: (+44) 01344 74 67 66
Fax: (+44) 01344 74 67 04
Email: [log in to unmask]
<mailto:[log in to unmask]>
I think you have been watching too many peugoet ads, which are probably
more interesting than McDonald's ad. There is quite a bit of stuff
published in the cardiology medical journals about inter and intra
obvesrer variability, but I don't know if anyone has looked at sex.
Generally, nurses are more consistent with their readings using a
sphygmotonometer than Doctors. As the major of hypertensives are male
and the majority nurses are female, it is likely to see an relationship
between high blood pressure in males and the sex of the person (nurse)
taking the reading if you were to look at observational data alone.
A person's blood pressure is significantly variable through the day and
undoubtly sex of reader could influence it, but then whether it was
Babs Windsor or Hatty Jakes taking you BP equally could influence the
result, so you would need to add that as factor in your model too.
Generally the value of sphygmotonometry in clinical research is
questionable and we much prefer 24 hour Ambulatory Blood pressure
monitoring these days to get a picture of over all blood pressure
control, throughout the day. The problem we than have is ensuring there
are no England v Germany football matches going on while we are
monitoring otherwise we have a lot of outliers to investigate.
Bob Shaw
Omnicare Clinical Research Ltd.,
I think it is true - our clinical pharmacology units use automatic BP
readings to try and remove a "rater" effect. I know myself that my GP
has to take 3 readings - not because of any attraction effect, just
because my mild hypochondria convinces me I'm in for something fatal and
BP reacts accordingly.
I think (as a gay bloke) that my BP would increase more with a female
rater due to psychological expectation - but this is getting Freudian!
kind regards
Graeme
Graeme Archer Ph.D., C.Stat.
Statistical and Data Sciences CEDD Leader, Psychiatry
GlaxoSmithKline,
Harlow, Essex
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Martin Bland
Prof. of Medical Statistics
St. George's Hospital Medical School
London SW17 0RE
[log in to unmask]
http://www.sghms.ac.uk/depts/phs/staff/jmb/jmb.htm
044 (0)20 8725 5492
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