Nurses are less likely to send patients’ blood pressure soaring than doctors, according to new research into the so-called “white coat effect”.
A review led by Exeter University found doctors routinely record blood pressure levels significantly higher – by 7/4mmHg – than those recorded by nurses checking the same patients.
The findings, published in the British Journal of General Practice, suggest doctors are more likely to bring on the “white coat effect” – heightened blood pressure from the fear and anxiety of being examined by a healthcare professional.
The researchers compared pressure levels in 1,019 patients whose measurements were taken by both nurses and doctors during the same practice visit.
The study showed higher readings taken by doctors could “tip” some patients over the hypertension treatment threshold, and so may end up being prescribed unnecessary drugs or asked to continue to monitor their own blood pressure at home, which can build anxiety.
Lead researcher Dr Christopher Clark said: “GPs might be over-estimating blood pressure because of this ‘white coat effect’ and therefore referring more people into further investigation than would be the case if it was a nurse-managed system.”
“There’s an impression nurses are more likely to measure blood pressure properly”
As well as differences in the white coat effect, he said the differences in blood pressure measurements could also be down to doctors “being a bit less diligent in following guidelines” than their practice nurses.
“There’s an impression nurses are more likely to measure blood pressure properly according to protocol than a doctor, who may be squeezing it into a consultation that includes several other things,” he told Nursing Times.
The researchers argue it would be better for nurses, rather than GPs, to do blood pressure checks when decisions are being made about adjusting hypertension treatment.
“Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome,” said Dr Clark.
The findings will feed into a much wider systematic review of nurse and allied health professional-led care for hypertension.
- Read the full study paper in the BJGP