High Prevalence of Insecure Attachment in Patients with Primary Hypertension.

Elisabeth M Balint,Dan Pokorny,Anna Buchheim,Christiane Waller,Manuela Gander,Alexandra Funk

doi:10.3389/fpsyg.2016.01087

Elisabeth M Balint, Dan Pokorny + Show 4 more

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https://doi.org/10.3389/fpsyg.2016.01087

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Abstract

Hypertension is a major cardiovascular (CV) risk factor and is predicted by heightened CV reactivity to stress in healthy individuals. Patients with hypertension also show an altered stress response, while insecure attachment is linked to a heightened stress reactivity as well. This is the first study aiming to assess attachment representations in patients with primary hypertension and to investigate their CV responses when their attachment system is activated. We studied 50 patients (38 men, 12 women) with primary hypertension. The Adult Attachment Projective Picture System (AAP), a widely used and validated interview, was performed to measure the patients' attachment representations, and to activate their attachment system. Blood pressure and heart rate were measured after 10 min at rest prior to and directly after the AAP interview. Mood and state anxiety were assessed using the Multidimensional Mood State Questionnaire (MDBF) and the State Trait Anxiety Inventory-State (STAI-S) before and after the experiment. The prevalence of insecure attachment (dismissing, preoccupied, unresolved) in hypertensive patients was predominant (88%), while in non-clinical populations, only about 50% of individuals had insecure attachment patterns. Blood pressure (p < 0.001), heart rate (p = 0.016), and rate pressure product (p < 0.001) significantly increased in response to the attachment interview. Secure attached patients showed the highest rise in systolic blood pressure (p = 0.020) and the lowest heart rate compared to the other attachment groups (p = 0.043). However, attachment representation showed no significant group or interaction effects on diastolic blood pressure (DBP) and rate pressure product. Insecure attachment was highly over-represented in our sample of patients with primary hypertension. Additionally, a robust CV response to the attachment-activating stimulus was observed. Our data suggest that insecure attachment is significantly linked to primary hypertension, which implies the need for further investigations to evaluate attachment insecurity as a possible risk factor for hypertension.

Highlights

Arterial hypertension represents a major cardiovascular (CV) risk factor worldwide and accounts for approximately 9.4 million deaths per year
In other clinical populations that were examined using the Attachment Interview (AAI), the proportion of insecure attachment found in patients with somatoform disorders was 74% (Waller et al, 2004) and with mental disorders 77% (Bakermans-Kranenburg and Van IJzendoorn, 2009), which is similar to our results
Our results demonstrate that insecure attachment is highly prevalent in patients with primary hypertension and almost twice as frequent as in non-clinical individuals (Bakermans-Kranenburg and Van IJzendoorn, 2009)

Summary

Introduction

Arterial hypertension represents a major cardiovascular (CV) risk factor worldwide and accounts for approximately 9.4 million deaths per year. Primary hypertension refers to a group of patients with no secondary causes like pheochromocytoma, renal failure, aldosteronism, or renovascular diseases and it accounts for almost 95% of all cases of hypertension (Carretero and Oparil, 2000) Among other factors, it is predicted by heightened (CV) reactivity to stress (Matthews et al, 1993, 2004; Carroll et al, 2013). Potential pathways include changes in physiological stress systems, immunity, health-, and risk behavior (Maunder and Hunter, 2001, 2008, 2009; Gander and Buchheim, 2015) Based on these concepts, attachment has been further evaluated in a broad context using different measures of attachment, mostly self-report. A high prevalence of insecure attachment has been shown in patients with somatic and somatoform diseases: 70% in diabetes (Ciechanowski et al, 2001), 72% in patients with ulcerative colitis (Maunder et al, 2000), and 74% in somatoform disorders (Waller et al, 2004)

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