Association of Depression and Anxiety With Hypertensive Crisis: A Cross-Sectional Study From a Hospital Setting in Karachi, Pakistan

Abstract

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.

Medication Adherence in Patients With Uncontrolled Hypertension & Hypertensive Crisis Presenting to a Hospital Setting in Karachi, Pakistan

“…Some studies used a validated questionnaire to assess adherence, while others measured antihypertensive medication levels in blood or urine. The reason for non-adherence in patients with a hypertensive crisis could be that they are more likely to have anxiety as reported in our previous study that 59% of patients with hypertensive crisis had anxiety, although the association could not reach statistical significance [ 30 ].…”

Sex and age differentials among people living with hypertension across the life course: evidence from a national survey in Bangladesh

“…Some studies showed that anxiety and depression may be related to the rise of BP while other studies showed a transient sympathetic mediated rise in BP due to stress (72)(73)(74)(75). Though more studies are required to undoubtedly establish a direct relationship between stress, anxiety, and depression with hypertension, stress-whether emotional, social, cultural, or occupational-may lead to several illnesses including the development of hypertension (76).…”