OBJECTIVES: To identify response shift using two structural equation modeling (SEM) techniques with the SF-36 Health Survey. METHODS: Hypertensive patients with coronary artery disease (CAD) who completed both baseline and one year follow-up of the SF-36 were included (n=909). An occurrence of response shift using Oort and Schmitt SEM techniques was specifically identified. LISREL software was used to conduct SEM procedures. A variety of fit indices were used to determine model fit. For both SEM approaches, response shift is defined based on changes in various parameters in the measurement model. Effect size indices were calculated for the contribution of response shift on the change of SF-36 domains scores. We hypothesized the divergence in defining type of response shift linked to changes in various parameters will lead to different findings. RESULTS: Only the SF-36 physical functioning (PF) scale was identified with recalibration response shift by using both Oort and Schmitt SEM approaches. With Oort approach, recalibration was identified by the change in intercepts, whereas Schmitt approach defines recalibration as the change in factor variances or factor loadings over time. Effect size of the recalibration response shift on the change of PF domain scores was marginal: -0.118. CONCLUSIONS: This is the first study to identify response shift in hypertensive CAD patients using SEM approach. Recalibration response shift was identified using both Oort and Schmitt SEM approaches. Different interpretation of specific PF items by hypertensive CAD patients before and after treatments may contribute to the recalibration response shift. By looking more closely at the SF-36 PF domain scores among hypertensive CAD patients will enable us to provide nuanced attention and direct treatment for the most impaired aspects of quality of life.