Abstract P242: Psychological Distress Related To Hypertension Diagnostic Testing And Diagnosis

Background: Little information is available as to whether undergoing hypertension diagnostic testing or receiving a new diagnosis of hypertension leads to psychological distress. Design, Setting, and Participants: BP CHECK was a randomized diagnostic study of 510 adults aged 18-85. Participants had elevated BP in clinic at baseline but no previously diagnosed hypertension. The trial was conducted from 2017 to 2019 in primary care centers of an integrated healthcare system. Participants were randomized to one of three diagnostic regimens: (1) Clinic BP, (2) Home BP, or (3) Kiosk BP. All participants completed 24-hour ambulatory blood pressure monitoring (ABPM) at 3 weeks. ABPM results were sent to participants and their primary care providers and uploaded into the electronic health record. This analysis includes a subset of participants (n=255) who completed psychological distress questionnaires at baseline, and at least one follow-up (after completing their diagnostic regimen and 6 months after randomization) Main Outcomes and Measures: The primary outcomes were within-person change in psychological distress (impact of events and state anxiety scales, BP worry Likert 5-point scale) comparing baseline to 3 weeks and 6 months post-enrollment. Results: Participants were half female (127/255), mostly > age 50 (78%), and White race (83%). Baseline mean BP was 150 mmHg systolic and 80 mmHg diastolic; 63.9% had hypertension on ABPM (daytime average > 135/85 mmHg). There was no significant change in impact of events or state anxiety at either follow-up. BP worry was significantly increased at 3 weeks (mean change 0.22 (0.13-0.30), but not at 6 months. Six month outcomes were not influenced by ABPM test results or receiving a hypertension diagnosis. Conclusion and Relevance: The hypertension diagnostic process increased hypertension worry short term, but not longer-term. It had little impact on other measures of psychologic distress. The risk of psychologic distress after hypertension diagnostic testing and receipt of a hypertension diagnosis appears to be low, reinforcing the importance of timely hypertension diagnoses. Additional studies with more diverse patient populations are needed.