Correlations between the dynamics of anxiety level and the efficacy of antihypertensive therapy: Results of a prospective observational study
Abstract. The influence of anxiety disorders at the efficacy of antihypertensive therapy (AHT) has not been sufficiently studied, especially in prospective research works. The aim: to estimate correlations between dynamic changes of anxiety and blood pressure (BP) in patients with arterial hypertension (AH) during AHT. Material and methods. 162 patients with stage I–II arterial hypertension, aged 51.0 ± 7.8 years, were examined. Blood pressure was measured in all participants, and daily blood pressure monitoring was performed. Anxiety level was assessed using the HADS scale. AHT was prescribed with dose correction after 2, 4, and 12 weeks. At the end of the observation period (24 weeks), repeated daily blood pressure monitoring was performed. Blood pressure dynamics during AHT were assessed in relation to the anxiety level at baseline and after 24 weeks. Results. Subclinical and clinically expressed anxiety was initially detected in 42.6% of cases (n = 69). During treatment, the degree of reduction of office blood pressure in patients with anxiety was less than in the group of patients without it (-31.0/-16.0 versus -37.0/-21.0 mm Hg, respectively; p < 0.05). The initial anxiety level directly correlated with the degree of reduction of the office systolic (r = +0.16; p = 0.046) and diastolic BP (r = +0.16; p = 0.036). Association of the degree of BP reduction with the presence of anxiety disorder was fixed in a linear regression with one regressor, but after adjustment for possible confounders, it lost its significance. The smallest decrease of average daily BP against the background of AHT (-13.0/7.4 mm Hg) was noted in the subgroup of initially anxious patients, in whom the anxiety level was normalized by the end of the observation period. This correlation retained statistical significance in the regression model fully adjusted for gender, age, body mass index, and initial BP. Conclusion. Subclinically and clinically expressed anxiety disorders took place in almost half of the patients with stage I–II arterial hypertension studied by us. With initially elevated anxiety level, the degree of blood pressure reduction with AHT was less than in patients without anxiety disorder. The lowest efficacy of AHT was associated with normalization of initially elevated anxiety level.Fedorishina O.V., Protasov K.V., Torunova A.M.
Keywords
arterial hypertension
blood pressure
antihypertensive therapy
anxiety
HADS
References
1. Şahin B, İlgün G. Risk factors of deaths related to cardiovascular diseases in World Health Organization (WHO) member countries. Health Soc Care Community. 2022;30(1):73–80.
PMID: 32909378. https://doi.org/10.1111/hsc.13156
2. Баланова Ю.А., Драпкина О.М., Куценко В.А., Имаева А.Е., Концевая А.В., Максимов С.А. с соавт. Артериальная гипертония в российской популяции в период пандемии COVID-19: гендерные различия в распространенности, лечении и его эффективности. Данные исследования ЭССЕ-РФ3. Кардиоваскулярная терапия и профилактика. 2023;22(S8):105–120. (Balanova YuA, Drapkina OM, Kutsenko VA, Imaeva AE, Kontsevaya AV, Maksimov SA et al. Hypertension in the Russian population during the COVID-19 pandemic: Sex differences in prevalence, treatment and its effectiveness. Data from the ESSE-RF3 study. Cardiovascular Therapy and Prevention. 2023;22(S8):105–120 (In Russ.)).
EDN: YRUNUX. https://doi.org/10.15829/1728-8800-2023-3785
3. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9(2):137–150.
PMID: 35026139. PMCID: PMC8776563. https://doi.org/10.1016/S2215-0366(21)00395-3
4. Qiu T, Jiang Z, Chen X, Dai Y, Zhao H. Comorbidity of anxiety and hypertension: Common risk factors and potential mechanisms. Int J Hypertens. 2023;2023:9619388.
PMID: 37273529. PMCID: PMC10234733. https://doi.org/10.1155/2023/9619388
5. Santosa A, Rosengren A, Ramasundarahettige C, Rangarajan S, Gulec S, Chifamba J et al. Psychosocial risk factors and cardiovascular disease and death in a population-based cohort from 21 low-, middle-, and high-income countries. JAMA Netw Open. 2021;4(12):e2138920.
PMID: 34910150. PMCID: PMC8674745. https://doi.org/10.1001/jamanetworkopen.2021.38920
6. Lim L-F, Solmi M, Cortese S. Association between anxiety and hypertension in adults: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2021;131:96–119.
PMID: 34481847. https://doi.org/10.1016/j.neubiorev.2021.08.031
7. Bigalke JA, Durocher JJ, Greenlund IM, Keller-Ross M, Carter JR. Blood pressure and muscle sympathetic nerve activity are associated with trait anxiety in humans. Am J Physiol Heart Circ Physiol. 2023;324(4):H494–H503.
PMID: 36800506. PMCID: PMC10259854. https://doi.org/10.1152/ajpheart.00026.2023
8. Qi H, Wen F-Y, Xie Y-Y, Liu X-H, Li B-X, Peng W-J et al. Associations between depressive, anxiety, stress symptoms and elevated blood pressure: Findings from the CHCN-BTH cohort study and a two-sample Mendelian randomization analysis. J Affect Disord. 2023;341:176–84.
PMID: 37598715. https://doi.org/10.1016/j.jad.2023.08.086
9. Bhat SK, Beilin LJ, Robinson M, Burrows S, Mori TA. Relationships between depression and anxiety symptoms scores and blood pressure in young adults. J Hypertens. 2017;35(10):1983–91.
PMID: 28505062. https://doi.org/10.1097/HJH.0000000000001410
10. Кобалава Ж.Д., Конради А.О., Недогода С.В., Шляхто Е.В., Арутюнов Г.П., Баранова Е.И. с соавт. Артериальная гипертензия у взрослых. Клинические рекомендации 2024. Российский кардиологический журнал. 2024;29(9):230– 329. (Kobalava ZhD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI et al. Clinical practice guidelines for Hypertension in adults. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2024;29(9):230–329 (In Russ.)).
EDN: GUEWLU. https://doi.org/10.15829/1560-4071-2024-6117
11. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.
PMID: 6880820. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
12. Морозова М.А., Потанин С.С., Бениашвили А.Г., Бурминский Д.С., Лепилкина Т.А., Рупчев Г.Е. с соавт. Валидация русскоязычной версии Госпитальной шкалы тревоги и депрессии в общей популяции. Профилактическая медицина. 2023;26(4):7–14. (Morozova MA, Potanin SS, Beniashvili AG, Burminsky DS, Lepilkina TA, Rupchev GE et al. Validation of the Hospital Anxiety and Depression Scale Russian-language version in the general population. Profilakticheskaya meditsina = Russian Journal of Preventive Medicine. 2023;26(4):7–14 (In Russ.)).
EDN: REKRGE. https://doi.org/10.17116/profmed2023260417
13. Storer B, Kershaw KA, Braund TA, Chakouch C, Coleshill MJ, Haffar S et al. Global prevalence of anxiety in adult cardiology outpatients: A systematic review and meta-analysis. Curr Probl Cardiol. 2023;48(11):101877.
PMID: 37336306. https://doi.org/10.1016/j.cpcardiol.2023.101877
14. Uphoff EP, Newbould L, Walker I, Ashraf N, Chaturvedi S, Kandasamy A et al.; NIHR Global Health Research Group – IMPACT. A systematic review and meta-analysis of the prevalence of common mental disorders in people with non-communicable diseases in Bangladesh, India, and Pakistan. J Glob Health. 2019;9(2):020417.
PMID: 31893031. PMCID: PMC6925965. https://doi.org/10.7189/jogh.09.020417
15. Fontes MAP, Marins FR, Patel TA, de Paula CA, Dos Santos Machado LR, de Sousa Lima ÉB et al. Neurogenic background for emotional stress-associated hypertension. Curr Hypertens Rep. 2023;25(7):107–16.
PMID: 37058193. PMCID: PMC10103037. https://doi.org/10.1007/s11906-023-01235-7
16. Allgulander C. Anxiety as a risk factor in cardiovascular disease. Curr Opin Psychiatry. 2016;29(1):13–17.
PMID: 26575295. https://doi.org/10.1097/YCO.0000000000000217
17. Hamam MS, Kunjummen E, Hussain MS, Nasereldin M, Bennett S, Miller J. Anxiety, depression, and pain: Considerations in the treatment of patients with uncontrolled hypertension. Curr Hypertens Rep. 2020;22(12):106.
PMID: 33170388. https://doi.org/10.1007/s11906-020-01117-2
18. Yin G, Li Y, Xu W, Han N. Chart review of patients receiving valsartan-amlodipine single-pill combination versus valsartan and amlodipine combination for blood pressure goal achievement and effects on the Hamilton anxiety rating / Hamilton depression rating scales. Medicine (Baltimore). 2019;98(51):e18471.
PMID: 31861026. PMCID: PMC6940181. https://doi.org/10.1097/MD.0000000000018471
19. Фофанова Т.В., Агеев Ф.Т., Кадушина Е.Б., Дробижев М.Ю., Смирнова М.Д., Кузьмина А.Е. Психосоматические аспекты низкой приверженности больных артериальной гипертонией медикаментозной терапии. Системные гипертензии. 2014;11(3):11–16. (Fofanova TV, Ageev FT, Kadushina EB, Drobizhev MYu, Smirnova MD, Kuzmina AE. Psychosomatic aspects of low adherence to antihypertensive therapy in patients with arterial hypertension. Sistemnye gipertenzii = Systemic Hypertension. 2014;11(3):11–16 (In Russ.)). EDN: SXKIUZ.
20. Bautista LE, Vera-Cala LM, Colombo C, Smith P. Symptoms of depression and anxiety and adherence to antihypertensive medication. Am J Hypertens. 2012;25(4):505–11.
PMID: 22258334. PMCID: PMC3588114. https://doi.org/10.1038/ajh.2011.256
About the Authors
Olga V. Fedorishina, MD, PhD (Medicine), associate professor of the Department of cardiology and functional diagnostics, Irkutsk State Medical Academy of Postgraduate Education – a branch of the Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 664049, Irkutsk, 100 Yubileyny Microdistrict.E-mail: olff@mail.ru
ORCID: https://orcid.org/0000-0002-0155-676X. eLibrary SPIN: 5380-4524
Konstantin V. Protasov, MD, Dr. Sci. (Medicine), professor, head of the Department of cardiology and functional diagnostics, Irkutsk State Medical Academy of Postgraduate Education – a branch of the Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 664049, Irkutsk, 100 Yubileyny Microdistrict.
E-mail: k.v.protasov@gmail.com
ORCID: https://orcid.org/0000-0002-6516-3180. Scopus ID: 14523447800. eLibrary SPIN: 7898-9690
Anna M. Torunova, MD, assistant at the Department of cardiology and functional diagnostics, Irkutsk State Medical Academy of Postgraduate Education – a branch of the Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 664049, Irkutsk, 100 Yubileyny Microdistrict.
E-mail: torunova.am@gmail.com
ORCID: https://orcid.org/0000-0001-9588-1709. eLibrary SPIN: 4154-9190
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