Abstract
Aim: To investigate the association of uncontrolled hypertension with psychological factors associated with high cardiovascular morbidity and mortality (type D personality, depression, posttraumatic stress-related symptoms). Methods: 205 consecutive outpatient hypertensives completed three questionnaires evaluating Type D personality (DS 16), post traumatic symptoms (revised Impact of Events Scale), symptoms of anxiety, hostility, depression and obsessive-compulsive traits (subscales of the Symptom Checklist). Uncontrolled hypertension was diagnosed when clinic sitting blood pressure was above 140/90 mmHg (130/80 in the presence of diabetes or nephropathy), despite reported adherence to treatment with at least three antihypertensive medications, including a diuretic. Results: Uncontrolled hypertension (39%), was predicted by lower scores at Symptom Checklist obsessive-compulsive subscale and higher number of post traumatic avoidance symptoms, older age, diabetes, higher systolic pressure at first visit and longstanding hypertension. Type D personality correlated with depression, hostility, anxiety, compulsiveness, history of malignancy, and older age, but not with uncontrolled hypertension. Conclusions: Uncontrolled hypertension is associated with low obsessionality and avoidance symptoms, which reduce compliance to treatment. On the contrary, type D personality is not correlated with uncontrolled hypertension, as it includes compulsiveness, which improves compliance. A multidisciplinary approach to the hypertensive patient is mandatory to establish if the psychological profile affects compliance.
Highlights
The two groups did not differ for clinical and demographic characteristics (age, sex, blood pressure at first and last visit, body mass index (BMI), number of outpatient consultations, duration of known hypertension, number of antihypertensive drugs, total vascular events, diabetes, malignancy, use of antidepressants or benzodiazepines, data not shown), but the number of cardiovascular events (history of myocardial infarction or angina) was more frequent among the patients with secondary hypertension (3/21 vs 4/184, χ2 = 8.38; p < 0.005)
Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Psychiatric Clinic, Department of Neuroscience, University of Padua, Policlinico Universitario, Via
The present study shows that uncontrolled hypertension is associated with low obsessionality and a large number of post-traumatic avoidance symptoms
Summary
The two groups did not differ for clinical and demographic characteristics (age, sex, blood pressure at first and last visit, BMI, number of outpatient consultations, duration of known hypertension, number of antihypertensive drugs, total vascular events, diabetes, malignancy, use of antidepressants or benzodiazepines, data not shown), but the number of cardiovascular events (history of myocardial infarction or angina) was more frequent among the patients with secondary hypertension (3/21 vs 4/184, χ2 = 8.38; p < 0.005). The clinical and demographic characteristics (age, sex, blood pressure at first and last visit, BMI, number of outpatient consultations, known duration of hypertension, number of antihypertensive drugs, use of antidepressant drugs, type of hypertension, rate of response to treatment, diabetes, malignancy) were similar between the patients who returned the questionnaire and those who did not (data not shown).
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