Psychological factors associated with non-contolled hypertension

INTRODUCTION: The management of arterial Hypertension (AH) is one of the major public health challenges. In fact, despite the development of many specific medical drugs, many patients are unable to keep their blood pressure (BP) under control. Although the role of psychological aspects in the genesis and maintenance of AH is extensively studied, little is known about the role that these may have on BP control. AIM: To analyse the relationship between anger expression, type D personality, and BP control. METHODS: One-hundred and Fifty-five pharmacologically treated AH participants undergoing ABPM were divided into two groups: controlled hypertension (CH; N = 84) and non-controlled hypertension (NCH; N = 68). All compiled STAXI to evaluate anger and DS14 to analyse negative affectivity and social inhibition. RESULTS: The State and Trait anger were not different in the two groups. On the contrary, significant differences were observed in the expression of anger (F1,150 = 18.31; p.01; pn2 = 0.10) both internalized (F1.150 = 12.23; p.001; pn2 = 0.07) that externalized (F1.150 = 8.28; p.001; pn2 = 0.05), with higher scores in the NCH participants. Furthermore, a significant difference was found in the control of anger (F1,150 = 5.73; p.05; pn2 = 0.04); which was lower in the NCH participants. NCH participants also showed higher levels of negative affectivity (F1.148 = 4.27; p.05; pn2 = 0.03) and social inhibition (F1.148 = 8.95; p.01; pn2 = 0.06). CONCLUSIONS: It is well-known that a maladaptive expression of anger has an essential role in the genesis of AH. These findings it seems to play a role in the lack of control of BP in patients with AH. Furthermore, NCH patients would have higher levels of negative affectivity and social inhibition, typical traits of type D personality. Drug resistance in AH is a significant problem; in fact, NCH patients have a risk of developing cardiovascular complications comparable to that of untreated hypertensive subjects. Although the role of the psychological dimensions assessed in this study appears moderate, considering such individual traits may favour patient-care and help to provide more effective AH care