ABSTRACT
BACKGROUND: Hypertension is an established risk factor for cardiovascular disease. Non-adherence to antihypertensive medications contributes to poorly controlled hypertension while also increasing the risk of hypertensive crisis. The aim of our study was thus to estimate the frequency of adherence to antihypertensive medications in our population and also see if an association exists between adherence and the development of a hypertensive crisis. METHODS: This cross-sectional study was undertaken on patients admitted to Aga Khan University Hospital, Karachi, Pakistan, between July 2020 and March 2022. All patients with uncontrolled hypertension with systolic blood pressure >140 and diastolic blood pressure >90 who were admitted through the emergency department were included. A systolic blood pressure over 180mmHg or diastolic blood pressure over 120mmHg, with or without end-organ damage was used to define a hypertensive crisis. Adherence to medications was assessed using the 4-item Morisky Green Levine (MGL) scale. Each item was scored as 1 and then added together to get a final score out of 4 with a score of ≥3 signifying adherence while a cumulative score of 0, 1, or 2 was classified as non-adherence. RESULTS: We found that 64% of the cohort were adherent to their medications while 93 (36%) were non-adherent. The most common comorbid condition was found to be diabetes mellitus (54.8%). Around 146 (64.6%) patients were on a single anti-hypertensive agent. Depression as calculated according to the hospital anxiety and depression scale (HADS) was seen in 133 (51.2%) of our cohort while 147 (56.5%) had anxiety. Similar rates of adherence were seen amongst males (49.1%) and females (50.9%). The highest level of adherence was seen in the 61 to 75 years age group (34.9%) and in those with university-level education (30.6%). We also found a statistically significant association between adherence to antihypertensive medications with anxiety (p-value=0.048). Moreover, in the hypertensive crisis group, 40.7% of the patients were adherent to their antihypertensive medications while 54.8% were found to be non-adherent, with the p-value reaching statistical significance (p-value=0.028). CONCLUSION: We found a higher rate of adherence (64%) in this inpatient hypertensive population as compared to previous studies in our population. We also found that non-adherence is a risk factor for the development of a hypertensive crisis. Therefore, at clinic visits, physicians should assess their patient's adherence to antihypertensive medications to prevent the development of a hypertensive crisis.
ABSTRACT
Introduction Hypertension, a leading risk factor for cardiovascular death, has been closely linked with depression and anxiety. The aim of this study was to examine the association of depression or anxiety with hypertensive crisis in patients and also see if the association is affected by age group or gender. This was carried out in a hospital setting. Methods This cross-sectional study was conducted between July 2019 and March 2022 on 290 patients admitted to the Aga Khan University Hospital (AKUH), Karachi, Pakistan. All adult patients more than 18 years of age admitted with uncontrolled hypertension with a systolic blood pressure of >140 and a diastolic blood pressure of >90 admitted through emergency were included. A hypertensive crisis was defined as a systolic blood pressure greater than 180 mm Hg or a diastolic blood pressure greater than or equal to 120 mm Hg, with or without accompanying end organ damage. Symptoms of depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. Results Of the patients identified with uncontrolled hypertension, a total of 140 (48.3%) of the patients presented with a hypertensive crisis, while 150 (51.3%) did not have a hypertensive crisis at presentation. In the hypertensive crisis group, 60 (49.3%) had HADS scores consistent with depression, while 83 (59.3%) had HADS scores consistent with anxiety. In patients with hypertensive crisis, HADS depression and anxiety were most prevalent in the 61-75 age group (39.7%). In the comparison of gender, it was found that males and females with hypertensive crisis had an almost equal prevalence of anxiety (49.4% in males versus 50.6% in females). A slightly higher prevalence of depression was seen in females with hypertensive crises when compared to males. Conclusion We found no association between depression or anxiety with hypertensive crisis, and the association is not affected by age group or gender. However, do note that half of the patients with hypertensive crises had depression or anxiety. Future large multicentered studies are required to study the link in greater detail.
