Abstract P048: The Association Between Apparent Treatment Resistant Hypertension and Low Mental and Physical Functioning, Depressive Symptoms, and Stress.

Abstract

Apparent treatment resistant hypertension (aTRH) is associated with an increased risk of cardiovascular events. There are few data on the association between aTRH, health-related quality of life and psychological well-being. In the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=30,239), we evaluated the association between aTRH and low health-related quality of life, high stress, and depressive symptoms. Also, among those with aTRH we assessed the association of these psychological factors with all-cause mortality. Low mental and physical functioning were defined by SF-12 scores in the lowest quintile for the mental and physical component scores, respectively. High stress was defined as having a Cohen’s Perceived Stress score ≥ 7. Depressive symptoms were defined as having a Center for Epidemiologic Studies Depression score ≥ 4. aTRH was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg despite the use of 3 classes of antihypertensive medication or use of 4 or more classes of antihypertensive medication regardless of blood pressure level. Of the 13,961 REGARDS participants with hypertension included in this analysis 1,954 (14.0%) had aTRH. Low physical functioning was more common among those with versus without aTRH (Table 1). The prevalence of low mental functioning, high stress and depressive symptoms was not significantly different between those with and without aTRH. Among those with aTRH, low physical functioning and depressive symptoms were associated with all-cause mortality after multivariable adjustment [adjusted hazard ratio (95% CI), 1.34 (1.07-1.67); p=0.010 and 1.38 (1.04-1.85); p=0.029, respectively]. In contrast, low mental functioning and high stress were not associated with all-cause mortality. In summary, participants with versus without aTRH have a higher prevalence of low physical functioning, which was also associated with a higher mortality rate.