Abstract
Objective: In a pilot study including 35 patients with resistant hypertension, we documented associations between psychological profile, drug adherence and severity of hypertension. The current study aims to confirm and expand our findings in a larger sample of patients with resistant hypertension, using controlled hypertensive patients as comparator. Design and method: Patients with resistant hypertension were enrolled in hypertension centers from Brussels and Torino. Psychological profile was assessed using five validated questionnaires. Drug adherence was assessed by high-performance liquid chromatography-tandem mass spectrometry analysis of urine samples, and drug resistance by 24-hour ambulatory blood pressure adjusted for drug adherence. Results: The study sample otalised 144 patients, including 81 resistant and 63 controlled hypertensive patients. Mean adherence level was significantly lower in the resistant group (78.9% versus 92.7% in controlled patients, p-value = .022). In resistant hypertensive patients, independent predictors of drug adherence assessed by regression analysis were somatization, smoking status, acceptation and living with a partner, accounting for 46% of variability in drug adherence. Independent predictors of severity of hypertension were somatization, smoking status, admissions to emergency department and acceptation, accounting for 67% of variability in severity of hypertension. In contrast, in patients with controlled hypertension, the single predictors of either drug adherence or severity of hypertension were number of years of hypertension and, for severity of hypertension, alcohol consumption, accounting for only about 15–20% of variance. Conclusions: Psychological factors, mostly related to somatization and expression of emotions are strong, independent predictors of both drug adherence and severity of hypertension in resistant but not in controlled hypertensive patients.
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