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Obsessive-Compulsive and Post Traumatic Avoidance Symptoms Influence the Response to Antihypertensive Therapy: Relevance in Uncontrolled Hypertension
Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy
Psychiatric Clinic, Department of Neuroscience, University of Padua, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy
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; in revised form: 9 November 2009 / Accepted: 13 November 2009 / Published: 16 November 2009
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
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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.
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(3):82-93.
Realdi, Anna; Favaro, Angela; Santonastaso, Paolo; Nuti, Marco; Parotto, Emanuela; Inverso, Giulia; Leoni, Matteo; Macchini, Luisa; Vettore, Francesca; Calo, Lorenzo; Semplicini, Andrea. 2009. "Obsessive-Compulsive and Post Traumatic Avoidance Symptoms Influence the Response to Antihypertensive Therapy: Relevance in Uncontrolled Hypertension." Pharmaceuticals 2, no. 3: 82-93.