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J Hypertens. 2014 Oct;32(10):1987-92; discussion 1992. doi: 10.1097/HJH.0000000000000289.

Are personality traits associated with white-coat and masked hypertension?

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aFlorida State University College of Medicine, Tallahassee, Florida bNational Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA cHospital San Raffaele Pisana IRCCS, Rome dIstituto di Neurogenetica e Neurofarmacologia, Consiglio Nazionale delle Ricerche eUnità Operativa Complessa Cardiologia, Presidio Ospedaliero A. Businco, Cagliari, Italy.



Anxiety and other psychological dispositions are thought to be associated with blood pressure. This study tests whether personality traits have long-term associations with masked and white-coat effects.


A community-based sample of 2838 adults from Sardinia (Italy) completed the Revised NEO Personality Inventory, and 7 years later, blood pressure was assessed in the clinic and with ambulatory monitoring. Logistic regressions were used to test whether anxiety, neuroticism, extraversion, openness, agreeableness, and conscientiousness predicted the white-coat and masked hypertension phenomena. Age, sex, and antihypertensive medication use were tested as moderators.


Significant interactions were found between personality traits and antihypertensive medications in predicting masked and white-coat effects. Only among those taking antihypertensive medication, higher anxiety was associated with a higher risk of pseudo-resistant hypertension due to white-coat effect (odds ratio 1.39, 95% confidence interval 1.01-1.91) and higher conscientiousness was associated with a lower risk of masked uncontrolled hypertension (odds ratio 0.70, 95% confidence interval 0.49-0.99). There were no significant interactions with age or sex.


Among those on antihypertensive medications, anxious individuals were more likely to have pseudo-resistant hypertension due to white-coat effect and less conscientious individuals were at increased risk of masked uncontrolled hypertension. Particularly among anxious and less conscientious individuals, ambulatory monitoring may improve the tailoring of pharmacological treatments.

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