MASKED UNCONTROLLED HYPERTENSION IN TREATED HYPERTENSIVE PATIENTS IS NOT RELATED TO ANXIETY COMPARED TO TRUE CONTROLLED HYPERTENSION

Abstract

Objective: Masked uncontrolled hypertension in treated hypertensive patients (MUCH) is defined as controlled blood pressure (BP) in clinic (Automated office BP [AOBP] < 135/85 mmHg) but uncontrolled BP out-of-clinic as measured by 24-hr ambulatory blood pressure monitoring (ABPM, daytime readings >= 135/85 mmHg). In- and out-of-clinic anxiety levels in patients with MUCH compared to patients with true controlled hypertension have not been previously compared. Design and method: In this prospective evaluation, 181 patients with controlled hypertension were recruited from the Hypertension Clinic. The patients were recruited after having controlled BP readings at 3 or more clinic visits. All the patients were evaluated by in-clinic AOBP with use of the BpTRU device, out-of-clinic ABPM, 24-hr urine collection to detect antihypertensive medication adherence by high-performance liquid chromatography-tandem mass spectrometry and state-trait anxiety inventory (STAI) to index self-reported anxiety both in- and out-of-clinic. Eighty patients had controlled hypertension in clinic and by daytime ABPM, indicating true controlled hypertension. The remaining 85 patients were controlled in clinic but uncontrolled by daytime ABPM, consistent with MUCH. Of these, 48 true controlled and 55 MUCH patients were fully adherent with prescribed antihypertensive medications. Results: Anxiety state levels were similar in patients with true controlled hypertension and MUCH both in-clinic (33.2 ± 11.6 vs 30.9 ± 11.8, p = 0.454) and out-of-clinic (32.4 ± 10.8 vs 32.2 ± 11.2, p = 0.943). In addition, anxiety trait levels were also similar in patients with true controlled hypertension and MUCH in-clinic (34.4 ± 12.2 vs 31.6 ± 10.7, p = 0.376) and out-of-clinic (33.6 ± 10.7 vs 33.7 ± 11.2, p = 0.972). Conclusions: Assessment of state and trait demonstrates a similar anxiety levels in both MUCH and true controlled hypertensive patients’ in- and out-of-clinic. This lack of difference in self-reported anxiety levels suggest that MUCH is not attributable to greater levels of anxiety.