Psychological determinants of drug adherence and severity of hypertension in patients with apparently treatment-resistant vs. controlled hypertension

Figures & data

Table 1. Characteristics of apparently treatment-resistant and controlled hypertensive patients.

	ATRH N = 81	Controlled hypertensives N = 63	p-value
Age (years)	56 ± 12	58 ± 15	.375
Women (%)	39.5	50.8	.177
African origin (%)	14.8	1.6	.006
BMI (Kg/m²)	29.8 ± 4.6	28.1 ± 5.1	.037
Office systolic BP (mmHg)	157 ± 27	140 ± 18	<.001
Office diastolic BP (mmHg)	91 ± 17	79 ± 12	<.001
24-h systolic BP (mmHg)	144 ± 16	119 ± 6	<.001
24-h diastolic BP (mmHg)	89 ± 12	71 ± 6	<.001
N° of antihypertensive drugs	4.1 ± 1.2	2.4 ± 1.2	<.001
RAS-inhibitors (%)	98.7	87.3	.005
Calcium antagonists (%)	96.3	50.7	<.001
Spironolactone (%)	60.5	30.2	<.001
Other diuretics (%)	29.6	22.2	.319
Beta-blockers (%)	65.4	36.5	<.001
Central antihypertensives (%)	29.7	6.3	<.001
Alpha-blockers (%)	6.2	3.2	.409
N° years treated HTN	16 ± 10	11 ± 11	.005
N° ER admissions for HTN/year	.030 ± .953	.024 ± .582	.716
Total N° of drugs	5.2 ± 2.9	3.3 ± 2.2	<.001
eGFR (mL/min/1.73m²)	79 ± 19	80 ± 24	.781
Total cholesterol (mg/dL)	192 ± 42	201 ± 38	.186
LDL-cholesterol (mg/dL)	111 ± 38	119 ± 39	.217
Type 2 Diabetes (%)	22.2	11.1	.082
Smokers (%)	14.8	7.9	.204
University degree (%)	36.5	39.5	.714
Living with partner (%)	69.8	70.4	.938

ATRH: apparently treatment-resistant hypertensive patients; BP: blood pressure; BMI: body mass index; eGFR: estimated glomerular filtration rate; ER: emergency room; HTN: hypertension; RAS: renin-angiotensin system.

Figure 1. Distribution of drug adherence categories (%) in apparently treatment-resistant (ATRH, n = 81) vs. controlled (n = 63) hypertensive patients.

Table 2. Correlations between socio-demographic, health-related and psychological variables and adherence level.

ADHERENCE	ATRH	Controlled hypertensives
Parameters	N = 81	N = 63
Age	.238 (.031)	–
Smoking status	−.288 (.011)	–
Living with partner	−.243 (.026)	–
Number of years with HTN	–	−.412 (.019)
Number of ER admissions/year	−.302 (.012)	–
HTN in the family	.245 (.031)	–
TAS 2 – difficulty to describe feelings	−.247 (.019)	–
Total alexythimia	−.265 (.048)	–
CERQ – acceptation	.321 (.018)	–
CERQ – planification	.362 (.007)	–
CERQ – adaptive strategies	.374 (.006)	–
BSI – anxiety	−.286 (.017)	–
BSI – somatisation	−.469 (.001)	–

ATRH: apparently treatment-resistant hypertensive patients; BSI: Brief Symptom Inventory Questionnaire; ER: emergency room; CERQ: cognitive emotion regulation questionnaire; HTN: hypertension; TAS20: Toronto Alexithymia Scale.

Table 3. Correlation between socio-demographic, health-related and psychological variables and severity of hypertension based on 24-h Ambulatory Systolic BP.

Adjusted* 24-h Systolic BP	ATRH	Controlled hypertensives
Parameters	N = 81	N = 63
Age	−.312 (.008)	–
Smoking status	.279 (.019)	–
Alcohol	–	.363 (.008)
Education level	–	−.385 (.010)
Living with partner	.269 (.017)	–
Number of years with HTN	–	.361 (.042)
Number of ER admissions/year	.458 (<.001)	–
CERQ – acceptation	−.322 (.018)	–
CERQ – planification	−.272 (.031)	–
CERQ – adaptive strategies	−.267 (.037)	–
BSI – anxiety	.316 (.010)	–
BSI – somatisation	.463 (<.001)	–

*Adjusted for adherence level and the number of antihypertensive drugs prescribed per day.

ATRH: apparently treatment-resistant hypertensive patients; BP: blood pressure; BSI: brief symptoms inventory; HTN: hypertension; ER: emergency room; CERQ: cognitive emotion regulation questionnaire.

Table 4. Multivariable regression with stepwise backward selection for prediction of adherence level and severity of hypertension in patients with apparently treatment-resistant and controlled hypertension.

Apparently treatment-resistant hypertension	B	E.S.B.	β
Adherence
1^st predictor – Somatisation (BSI)	−.194	.038	−.478 (<.001)
2^nd predictor – Smoker	−.201	.059	−.342 (.001)
3^rd predictor – Acceptation (CERQ)	.042	.012	.302 (.005)
→ Explained 40.6 % of variability
Adjusted* 24-h Systolic BP
1^st predictor – Somatisation (BSI)	4.345	1.011	.399 (<.001)
2^nd predictor – Smoker	6.358	1.941	.290 (.011)
3^rd predictor – Number of ER admissions/y	2.661	1.058	.241 (.018)
4^th predictor – Acceptation (CERQ)	−.756	.281	−.234 (.012)
→ Explained 63.2 % of variability
Controlled hypertension	B	E.S.B.	β
Adherence
1st predictor – Number of years with HTN	−.007	.003	−.428 (.013)
→ Explained 15.3 % of variability
Adjusted* 24-h Systolic BP
1st predictor – Number of years with HTN	.213	.090	.403 (.020)
2nd predictor – Alcohol consumption	3.745	1.902	.319 (.043)
→ Explained 17.1 % of variability

*Adjusted for adherence level and number of antihypertensive drugs prescribed per day.

BP: blood pressure; BSI: brief symptoms inventory; CERQ: cognitive emotion regulation questionnaire; ER: emergency room; HTN: hypertension.