Psychosomatic aspects of low adherence to antihypertensive therapy in patients with arterial hypertension

Aim. To evaluate psychosomatic aspects of adherence to antihypertensive therapy (AHT) in patients with arterial hypertension and its relationships with comorbid somatic disturbances.Subjects and methods. A total of 161 patients with arterial hypertension with duration of more than 12 months (19 women, 42 men) aged 53,4±11,4 years were included in the study. All studied patients were followed up in the outpatient department of the Cardiology Research Institutenamed after A.L.Miasnikov, Russian Cardiology Research and Production Complex, Ministry of Health of the Russian Federation, and were consented for the psychiatric examination. To evaluate the patient adherence to AHT the following questionnaires and scales have been used: original Complaint Questionnaire designed by the authors for patients with arterial hypertension, USK, USK-B, ORB, GOTD, and patient self-reported Morisky-Green medication adherence scale. Consistent with data of patient case histories and responses to questionnaires, studied subjects were classified into two groups of adherence levels to AHT: Group I - 30 (19%) subjects; 17 women/13 men; mean age 52,9±11,7 years - included patients with high adherence to AHT, who started medication right after being diagnosed for arterial hypertension, and were treated regularly. Group II - 131 (81%) subjects; 102 women/29 men; mean age 53,1±11,8 years - included patients with low adherence to AHT, with postponed initiation of AHT after the diagnosis, and irregular or absent treatment.Results and conclusions. Patients comprising Group I with high adherence to AHT were characterized by short duration of arterial hypertension, crisis-type of its onset followed by panic attacks; concomitant disorders (ischemic heart disease, arrhythmias, ulcer disease, thyroid gland abnormalities), high anxiety level, panic attacks, anxiety and phobic paroxysms, subclinical depressions (dysthymia, cyclothymia), anxiodepressivesituational adaptation reactions, and nozogenic (adaptive) anxiodepressive reactions (hypernozognosia). Patients comprising Group II with low adherence to AHT were characterized by more severe affective symptoms (depressive and maniacal phases of bipolar affective disorder and recurrent depressions) and different variants of pathocharacterologic personality development.