PracticeUpdate Conference Series European Congress of Psychiatry 2019

Hypertension Linked With Increased Risk of Anxiety and Depression Systematic screening and earlymanagement of thesemental health disorders is needed in the hypertensive population. P atients with hypertension are more likely than those without it to suf- fer from anxiety and depression,

according to an analysis of patients from a general healthcare practice in Tunisia. The findings were presented in a poster at EPA 2019. The researchers highlight the need to screen for anxiety and depres- sion among patients with hypertension. “Anxiety and depression are common psychiatric comorbidities in patients diagnosed with hypertension, which may worsen the course of this disease,” write the investigators in their poster, which was presented by Nada Ghazouani, a psychiatry resident at the Medical School of Tunis in Tunisia. “The objective of our study was to evaluate the prevalence of anxiety and depression during hyperten- sion in a Tunisian cohort.” " This exploratory study is a welcome reminder to clinicians that depression, anxiety and hypertension can and do co-occur. " The investigators conducted a cross-sec- tional, comparative study of 200 patients recruited from a basic health center in the governorate of Mannouba, Tunisia. Among these patients, 100 had hyper- tension and 100 were controls who were matched with respect to age and gender. Anxiety and depression were assessed in both groups of patients using the Hospital Anxiety and Depression Scale (HADS). Overall, a greater proportion of patients with hypertension had anxiety, as deter- mined by an anxiety score >10, compared with control subjects (58% vs 22%, P < .0001). Similarly, depression, which was defined as a depression score >10,

was more frequently seen among those with hypertension than those without (27% vs 8%, P < .001). In addition, 24% of patients with hyper- tension had both an anxiety disorder and depression, compared with only 6% of controls (P < .001). “Our results emphasize the high preva- lence of anxiety disorders and depression in patients diagnosed with hypertension compared to a control group,” write the investigators in their poster. “Nevertheless, these disorders are still underdiagnosed in this population, which highlights the need for a systematic screening and an early management of these comorbidities.” In a comment on the study for Elsevier’s PraticeUpdate , Dennis Butler, PhD, Professor Emeritus of Family Medicine at the Medical College of Wisconsin in Milwaukee, noted that, “In the early days of psychosomatic medicine, a predom- inant theory was that anxiety caused hypertension. As research on essential hypertension evolved, attention shifted to examining how stress and distress con- tributed to hypertension. The subsequent

development of effective hypertensive agents then shifted clinicians’ attention to the importance of diet and exercise. Discussion of psychological factors played a less prominent role in encounters. “This exploratory study is a welcome reminder to clinicians that depression, anxiety and hypertension can and do co-occur,” he continued. “Further, it is safe to say that depression and anxiety do not contribute to the effective management of hypertension but certainly can interfere. “There does need to be further research in this area,” concluded Dr. Butler, “but such findings lend support to models of practice that incorporate mental health professionals in primary care to confirm psychiatric disorders and offer psycholog- ical and behavioral health interventions. This research does not support making causal statements about the relationship between depression/anxiety and hyper- tension, but it does remind us to help patients see the relationship between psyche and soma.”

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EPA 2019 • PRACTICEUPDATE CONFERENCE SERIES