DRUG ADHERENCE AND PSYCHOLOGICAL FACTORS MATTER IN PATIENTS WITH RESISTANT HYPERTENSION - YES BUT WHICH ONES?

Abstract

Objective: Altered psychological profiles are associated with drug adherence and drug resistance in patients with resistant hypertension (RHTN). However, treatment resistance may also result from increased arterial stiffness and target organ damage. The aim of this study was to assess the association of psychological factors with both drug adherence and drug resistance in two subtypes of patients with RHTN: younger patients without cardiovascular complications versus older or vascular patients. Design and method: Ninety-seven patients with RHTN were enrolled and split in two groups: patients 60y or older or with previous cardiovascular diseases (VRHTN), and younger patients without cardiovascular complications (NVRHTN). Drug adherence was assessed by urinary Liquid Chromatography coupled with tandem Mass Spectrometry. Drug resistance was evaluated by 24-hour ambulatory blood pressure adjusted for the number of antihypertensive drugs and drug adherence. Psychological profile was assessed using five validated questionnaires: the Brief Symptom Inventory (BSI), the Toronto Alexithymia Scale (TAS-20), the Emotion Regulation Questionnaire (ERQ), the Cognitive Emotion Regulation Questionnaire (CERQ) and the Post Traumatic Diagnostic Scale (PDS). Results: The proportion of fully adherent, partly adherent, and totally non-adherent patients was significantly different between NVRHTN (37, 39 and 24%) and VRHTN (67, 26 and 7 %) respectively (p-value = 0.010). After multiple regression analysis, independent predictors of poor drug adherence in NVRHTN were “adaptive strategies’’, male gender and family history of hypertension, accounting for 39.2% of the variability. Independent predictors of drug resistance were difficulties in planification and somatization, accounting for 39.0% of the variability. In the VRHTN group, predictors of drug adherence were yearly number of visits at the emergency department for hypertension and family history of cardiovascular events, accounting for 28.1% of the variability in drug adherence. Predictors of drug resistance were the number of visits at the emergency department and the total number of drugs prescribed per day, accounting for 35.0% of the variability in drug resistance. Conclusions: Poor drug adherence and altered psychological profiles appear to play a major role in younger patients with RHTN without cardiovascular complications. This subset of patients should be prioritized for assessment of drug adherence and psychological evaluation.