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Pharmaceuticals 2009, 2(3), 82-93; doi:10.3390/ph2030082
Article

Obsessive-Compulsive and Post Traumatic Avoidance Symptoms Influence the Response to Antihypertensive Therapy: Relevance in Uncontrolled Hypertension

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1 Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy 2 Psychiatric Clinic, Department of Neuroscience, University of Padua, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy 3 Division of General Medicine, SS. Giovanni e Paolo Hospital, Campo SS. Giovanni e Paolo, Castello 6777–30122 Venezia, Italy
* Author to whom correspondence should be addressed.
Received: 22 September 2009 / Revised: 9 November 2009 / Accepted: 13 November 2009 / Published: 16 November 2009
(This article belongs to the Special Issue Antihypertensive Drugs)
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Abstract

Aim: To investigate the association of uncontrolled hypertension with psychological factors associated with high cardiovascular morbidity and mortality (type D personality, depression, posttraumatic stress-related symptoms). Methods: 205 consecutive outpatient hypertensives completed three questionnaires evaluating Type D personality (DS 16), post traumatic symptoms (revised Impact of Events Scale), symptoms of anxiety, hostility, depression and obsessive-compulsive traits (subscales of the Symptom Checklist). Uncontrolled hypertension was diagnosed when clinic sitting blood pressure was above 140/90 mmHg (130/80 in the presence of diabetes or nephropathy), despite reported adherence to treatment with at least three antihypertensive medications, including a diuretic. Results: Uncontrolled hypertension (39%), was predicted by lower scores at Symptom Checklist obsessive-compulsive subscale and higher number of post traumatic avoidance symptoms, older age, diabetes, higher systolic pressure at first visit and longstanding hypertension. Type D personality correlated with depression, hostility, anxiety, compulsiveness, history of malignancy, and older age, but not with uncontrolled hypertension. Conclusions: Uncontrolled hypertension is associated with low obsessionality and avoidance symptoms, which reduce compliance to treatment. On the contrary, type D personality is not correlated with uncontrolled hypertension, as it includes compulsiveness, which improves compliance. A multidisciplinary approach to the hypertensive patient is mandatory to establish if the psychological profile affects compliance.
Keywords: avoidance symptoms; compliance; obsessive-compulsive symptoms; uncontrolled hypertension; type D personality avoidance symptoms; compliance; obsessive-compulsive symptoms; uncontrolled hypertension; type D personality
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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Realdi, A.; Favaro, A.; Santonastaso, P.; Nuti, M.; Parotto, E.; Inverso, G.; Leoni, M.; Macchini, L.; Vettore, F.; Calo, L.; Semplicini, A. Obsessive-Compulsive and Post Traumatic Avoidance Symptoms Influence the Response to Antihypertensive Therapy: Relevance in Uncontrolled Hypertension. Pharmaceuticals 2009, 2, 82-93.

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