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Labeling and hypertension: it is time to intervene on its negative consequences.

With the increasing prevalence of hypertension in the adult population, a good number of patients are potentially vulnerable to been mislabeled or misdiagnosed as hypertensive, with resultant negative consequences. Sir George Pickering raised the issue of labeling, when he suggested that hypertension labeling might evoke a feeling of fear of the affliction of a serious disease in a patient.1 This assertion has been proven accurate by numerous investigators who have documented the negative psychological consequences of hypertension labeling.2,3

The study by Hamer et al4 in this issue of the journal is yet another important reminder of the negative consequences of hypertension labeling. In a population-based cohort of >33 000 individuals (aged 51.7±12.1 years; 45.8% men), the authors assessed levels of psychological distress using the 12-item General Health Questionnaire, measured blood pressure, and collected history of hypertension diagnosis and medication usage. Awareness of hypertension (labeling) was confirmed through a physician diagnosis or the use of antihypertensive medication and being unaware of hypertension was defined by elevated clinic blood pressure >140/90 mm Hg without previous treatment or diagnosis. Compared with normotensive participants, an elevated risk of psychological distress was observed in aware hypertensive participants (multivariable adjusted odds ratio: 1.57 [95% CI: 1.41 to 1.74]) but not in unaware hypertensives (odds ratio: 0.91 [95% CI: 0.78 to 1.07]). Similar to previous studies, these findings confirm the negative psychological sequelae of hypertension labeling. Unlike previous studies, however, this is the largest population-based study of hypertension labeling to …