[PP.10.17] ANXIETY AND DEPRESSION AS PREDICTORS OF DRUG INTERRUPTION IN UNCONTROLLED HYPERTENSION

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Abstract

Objective:

Uncontrolled hypertension (UCHTN) is closely associated with poor prognosis and increased rate of cardiovascular events. Poor adherence to antihypertensive treatment is one of the most frequent reasons for non-target blood pressure (BP) level.

Objective:

The aim of the study was to assess the relationship between anxiety, depression and adherence (incidence of drug interruption) in ambulatory patients with UCHTN.

Design and method:

We examined 336 ambulatory patients with UCHTN (94 males and 242 females) 39 – 69 years old (mean age 54 ± 3 years) not on target in spite of combination of antihypertensive drugs. Repeated “office” BP measurements, ambulatory BP monitoring (ABPM), as well as screening for secondary HTN, were performed in all patients. Depression and anxiety levels were estimated by hospital anxiety and depression scale (HADS) and Spilberger test.

Results:

As a result of investigation “true” resistant HTN was confirmed in 46 patients (13,7%), secondary forms diagnosed in 74 (22%) cases and 21 (6,3%) patients had “white-coat” HTN. In 195 cases (59,1%) the main cause of non-target BP level was suboptimal treatment regimen. Among them 64 (32,8%) patients periodically interrupted drug intake due to different reasons.

Results:

Baseline indicators of personal and reactive anxiety were higher in noncompliant patients with UCHTN compared with age-matched patients with adherent patients with UCHTN (26 ± 1 and 27 ± 2 points, vs 23 ± 2 and 20 ± 3 points, P < 0,01). Depression level was maximal in noncompliant patients with UCHTN (16 ± 3 points, P < 0,01) and associated with 24-hours systolic BP (r = -0.46, P < 0.05). Systolic 24-hours BP variability was higher in noncompliant UCHTN patients with high-scoring depression and anxiety compared to age-matched adherent patients with UCHTN.

Conclusions:

Depression level may be predictor of inadequate adherence to treatment associated with drug interruption in patients with uncontrolled hypertension.

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