Psychological distress and blood pressure control: the association of anxiety, depression, and resistant hypertension

Abstract Background Depression and anxiety are common problems among hypertensive patients and are associated with increased mortality, greater health care expenditures and reduced quality of life. Purpose We sought to evaluate the association of anxiety and depression, as measured by the Hospital Anxiety and Depression (HADS) score, and blood pressure control, among hypertensive patients. Methods A total of 202 outpatients, suffering from primary hypertension (47.3 % women, median age 69.5, IQR 15.7) of a tertiary center in Cyprus were included. 188 patients (93%) had controlled hypertension, while 14 patients (7%) suffered from resistant hypertension. HADS score was recorded, along with its two subscales, HADS-D and HADS-A, measuring the components of depression and anxiety, respectively. Socioeconomic status variables, along with cardiovascular comorbidities, were also recorded (Table). Results Univariate logistic regression was applied (Table). HADS- T score and HADS- A were positively associated with uncontrolled hypertension (Odds Ratio 1.08, 95% CI 1.01 – 1.15, and Odds Ratio 1.15, 95% CI 1.03 – 1.28, per point increase, respectively). Diabetes mellitus and chronic kidney disease were also associated with resistant hypertension (Odds Ratio 9.03, 95% CI 2.37 – 59.16 and Odds Ratio 31.16, 95% CI 2.79 – 699, per point increase, respectively). Conclusion HADS score is associated with resistant hypertension. The anxiety component seems to be more pronounced that the depression component, along with the well- established risk factors of chronic kidney disease and diabetes mellitus.