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Título

TEMPERAMENT AND BLOOD PRESSURE CONTROL IN PATIENTS WITH RESISTANT HYPERTENSION

Resumo

INTRODUCTION: Negative emotions lead to sympathetic activation, release of catecholamines and increased Blood Pressure (BP). Ongoing debates persist on whether Anxious and/or Worrisome Temperament (AWT) impacts long-term BP Control (BPC).
PURPOSE: Correlate BPC and AWT in patients with Resistant Hypertension (RH).
METHODS: the study was done at Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, in 2023. Patients with RH were included, while those with atrial fibrillation, atrial flutter, any hospitalizations in the last 6 months or malignancy were excluded. Local ethics committee approved the study (61859722.1.0000.5243). In a single visit, patients underwent a clinical consultation and completed the TEMPS-A questionnaire, in Portuguese. Office BP was obtained using an electronic device (model HEM-705CP; Omron Healthcare Inc., Lake Forest, IL). Three BP readings were done, spaced by 1 minute. Home blood pressure measurement (HBPM) was done with the same cuff and electronic device used in office BP reading. Subjects were divided in three groups based on their TEMPS-A assessment: “No_AW” no evidence of AWT; “AW_Treat” with regular pharmacological treatment for AWT; “AW_Control” (AWC) no pharmacological treatment for AWT.
RESULTS: We included 48 patients. Table 1 shows clinical characteristics and comorbidities. As you may see, patients in group “AW_Control” had higher median HBPM, that were above guidelines treatment threshold. By the other hand, groups “AW_Treat” and “No_AW” had appropriate median HBPM.
DISCUSSION: In the present study, patients with anxious and/or worrisome temperament and without regular treatment had poorer blood pressure control than treated patients with AWT as well as patients without AWT. Previous studies have shown that pathophysiological mechanisms may be related to catecholamine release, reduced parasympathetic activation, and elevated levels of inflammatory markers. Cyclothymic and hyperthymic temperament did not show higher BP. However, our patients with anxiety and/or worrying had higher BP when measured at home – an important prognostic finding, as HBPM is a better predictor of cardiovascular events than office BP.
CONCLUSION: AWT is associated with worse BPC in RHBP.

Palavras Chave

Hipertensão Arterial Resistente; ansiedade; Adesão ao Tratamento

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