Anxiety disorders and depression are associated with resistant hypertension

Abstract

Background. Anxiety and depression can adversely affect theprognosis following cardiovascular diseases (CVDs) and may be associated with resistance to hypertension (HT) treatment. A better understanding of the complex biological substratum of resistant HT complicated by depression and anxiety is crucial for designing future primary care strategies. Objectives. Toevaluate therelationship between anxiety and depression and resistant HT, which will help tolook at resistant HT from abroader perspective and aid thedevelopment ofnew strategies for diagnosis and treatment. Materials and methods. We used a stratified random sampling method to select HT patients aged18 and older inprimary care setting. A total of300consecutive patients with persistent HT who were diagnosed with essential HT and uncontrolled blood pressure (BP) despite antihypertensive therapy were prospectively included inthestudy. Anxiety and depression were investigated, and scoring was evaluated using the Hospital Anxiety and Depression Scale (HADS). Results. Thestudy included 108controlled and 91uncontrolled HT patients. The HADS scales were higher inthecontrolled HT group compared totheuncontrolled HT group (6 (0–18) compared to9 (0–20), p=0.001; 5 (0–17) compared to7 (0–16), p<0.001, respectively). Body mass index (BMI) and C-reactive protein (CRP) were also significantly higher intheuncontrolled HT patients compared tothenormotensive group. Anxiety was associated with a 2.18 times increased risk of HT and a 1.99 times increased risk of depression. Thus, anxiety and depression predicted resistant HT inboth univariate and multivariate analyses. Conclusions. During thetreatment of HT, efforts should be made toimprove thepsychological and social functions of thepatients beyond theprimary therapy for control of thedisease. As such, wehope todraw attention totheimportance ofpsychological factors, especially anxiety and depression, inany field ofmedicine related to managing resistant HT.