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

IntroductionHypertension, 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. MethodsThis 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. ResultsOf 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. ConclusionWe 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.

Objective: 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 from a hospital setting and also see if the association is affected by age groups or gender. Design and method: This cross-sectional study was conducted between July 2019 and March 2022 on 290 patients admitted at the Aga Khan University Hospital (AKUH). All adult patients of more than 18 years of age admitted with uncontrolled hypertension with systolic blood pressure of > 140 and diastolic blood pressure > 90 admitted through emergency were included. Hypertensive crisis was defined as systolic blood pressure more than 180mm Hg or a diastolic blood pressure more than or equal to 120mm Hg, with or without accompanying end organ damage. Depression and Anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS), with a cut-off score of greater than 8. Results: Of the patients identified with uncontrolled hypertension, a total of 140 (48.3 percent) of the patients presented with a hypertensive crisis, while 150 (51.3 percent) did not have a hypertensive crisis at presentation. In the hypertensive crisis group, 60 (49. percent) had HADS scores consistent with depression, while 83 (59.3 percent) 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 percent). In the comparison of gender, it was found that males and females with hypertensive crisis had an almost equal prevalence of anxiety (49.4 percent in males versus 50.6 percent in females). A slightly higher prevalence of depression was seen in females with hypertensive crises when compared to males. Conclusions: 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.

Objective: 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 and also see if an association exists between adherence and the development of hypertensive crisis. Design and method: This cross-sectional study was undertaken on patients admitted to Aga Khan University Hospital between July 2020 and March 2022. All patients with uncontrolled hypertension with systolic blood pressure (BP) > 140 and diastolic BP > 90 were included. Hypertensive crisis was defined as a systolic BP over 180mm Hg or diastolic BP over 120mm Hg, with or without end organ damage. Adherence to medications was assessed using the 4 item Morisky Green Levine scale. A cumulative score of more than and equal to 3 signified adherence while a 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. Depression was seen in 133(51.2%) while 147(56.5%) had anxiety. Similar rates were seen amongst males (49.1%) and females (50.9%) when stratified by adherence. The highest level of adherence was seen in the 61-75 years age group (34.9%). We also found statistically significant association of 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 p value reaching statistical significance (p = 0.028). Conclusions: 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 hypertensive crisis. Therefore, at clinic visits, physicians should assess their patient's adherence to antihypertensive medications to prevent the development of a hypertensive crisis, which is a potentially life threatening complication of uncontrolled hypertension.