What is the clinical evidence from this study?

Study design: Observational. Population: Resistant hypertension (n=300). Intervention: Anxiety and depression vs. Controlled hypertension. Primary outcome: Resistant/uncontrolled hypertension (RR 2.18, p=<0.001).

June 30, 2023Open Access

Anxiety disorders and depression are associated with resistant hypertension

Q: What are the key findings of this study?

Anxiety and depression were significant predictors of resistant hypertension, with anxiety associated with a 2.18-fold increased risk of the condition.

Q: What does this research mean for the field?

Anxiety and depression are significant predictors of resistant hypertension, with anxiety associated with a 2.18-fold increased risk of the condition. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

HDHandan DumanRecep Tayyip Erdoğan University HDHakan DumanRecep Tayyip Erdoğan University MPMeltem PuşuroğluRecep Tayyip Erdoğan University

Key Result

Anxiety and depression were significant predictors of resistant hypertension, with anxiety associated with a 2.18-fold increased risk of the condition.

Study Design

Type

Observational (n=300)

Structured PICO

Are anxiety and depression associated with resistant hypertension in adult patients?

Population

300 adult patients (aged ≥18) with essential hypertension in a primary care setting, including 108 with controlled and 91 with uncontrolled (resistant) hypertension despite antihypertensive therapy.

Intervention

Presence of anxiety and depression (assessed via Hospital Anxiety and Depression Scale [HADS])

Comparator

Patients with controlled hypertension or without anxiety/depression

Outcome

Resistant/uncontrolled hypertensionpatient reported

Anxiety and depression are significant predictors of resistant hypertension, highlighting the importance of addressing psychological factors to improve blood pressure control.

Main Result

Effect estimate: RR 2.18

p-value: p=<0.001

Abstract

BACKGROUND: Anxiety and depression can adversely affect the prognosis 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: To evaluate the relationship between anxiety and depression and resistant HT, which will help to look at resistant HT from a broader perspective and aid the development of new strategies for diagnosis and treatment. MATERIAL AND METHODS: We used a stratified random sampling method to select HT patients aged 18 and older in primary care setting. A total of 300 consecutive patients with persistent HT who were diagnosed with essential HT and uncontrolled blood pressure (BP) despite antihypertensive therapy were prospectively included in the study. Anxiety and depression were investigated, and scoring was evaluated using the Hospital Anxiety and Depression Scale (HADS). RESULTS: The study included 108 controlled and 91 uncontrolled HT patients. The HADS scales were higher in the controlled HT group compared to the uncontrolled HT group (6 (0-18) compared to 9 (0-20), p = 0.001; 5 (0-17) compared to 7 (0-16), p < 0.001, respectively). Body mass index (BMI) and C-reactive protein (CRP) were also significantly higher in the uncontrolled HT patients compared to the normotensive 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 in both univariate and multivariate analyses. CONCLUSIONS: During the treatment of HT, efforts should be made to improve the psychological and social functions of the patients beyond the primary therapy for control of the disease. As such, we hope to draw attention to the importance of psychological factors, especially anxiety and depression, in any field of medicine related to managing resistant HT.

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