Hassle Hypertension: A Risk of Managed Care

To the Editor. —The role of psychological stress in the cause of hypertension has long been debated.^1,2 A patient's blood pressure rises in response to the stress of having his or her blood pressure checked by a physician.³ Dubbed "white coat hypertension," this effect has become an important consideration in the diagnosis of hypertension. A new effect on blood pressure— "managed care hypertension"—may pose a threat to physicians and other health care professionals.

A 44-year-old primary care physician complained of feeling stressed by telephone calls to managed care plans to request authorization for services needed by his patients. He noted tachycardia, feeling flushed, and the need to suppress frustration and anger. These telephone calls often required interruptions of patient care lasting 10 to 20 minutes in the midst of busy days in the office. To assess the effect of this stress, his nurse recorded his blood pressure regularly