Effect of psychosocial factors and heart ate variability on blood pressure control in patient with primary hypertension:A path analysis

Abstract

Abstract Background Hypertension (HTN) is one of the major factors driving the global burden of cardiovascular diseases. About 40% of the adults are affected by elevated blood pressure around the world. The etiology of HTN is multifactorial, including psychological distress, especially symptoms of anxiety and depression. A few meta-analyses and longitudinal studies have reported an association between symptoms of anxiety, depression and HTN. Social support is an important factor in the regulation of emotions in HTN patients. The autonomic nervous system (ANS) plays an important role in the homeostatic control of the cardiovascular system. The measurement of heart rate variability (HRV) is used to evaluate ANS regulation in clinical research.The HRV is also a predictor of cardiovascular-cause events and mortality. Previous studies have identified the association of cardiovascular diseases with social support, anxiety, and depression. Some recent studies have also evaluated the relationship between HRV and cardiovascular diseases. However, very few studies have investigated the association of psychosocial factors, HRV, and blood pressure in patients with HTN. Purpose The purpose of this study was to evaluate the effect of psychosocial factors including social support, symptoms of anxiety/depressive, and heart rate variability on mean arterial blood pressures in patients with primary hypertension. Methods A cross-sectional descriptive and correlative study was performed. Participants were recruited by convenience sampling from the Cardiovascular Outpatient Clinic at a Medical Center. Data were collected using structured questionnaires, including the Social Support and Hospital Anxiety and Depression Scales. While heart rate variability was measured by a handheld limb lead electrocardiogram recorder device, blood pressure was measured by an automatic sphygmomanometer. Data were analyzed by the structural equation path analysis by the IBM SPSS Amos 21.0 statistical software packages. Results This study included 301 patients with primary hypertension. The scores of the Social Support Scale had a significantly direct effect on the scores of Hospital Anxiety and Depression Scale. The Hospital Anxiety and Depression Scale scores had a significantly direct effect on the heart rate variability. The low frequency/ high-frequency ratio of heart rate variability had a significantly direct effect on the mean arterial blood pressures. The path model including all variables explained 45% variance in the mean arterial blood pressures and had good fit indices. Conclusion Findings from our research highlight the significance of how psychosocial factors can affect the autonomic nervous system and blood pressure control of patients with primary hypertension. These findings can aid in developing an intervention program for blood pressure management in future. Funding Acknowledgement Type of funding source: None