Hypertension treatment hurts quality of life, especially for women

By Hugo Francisco de SouzaReviewed by Lily Ramsey, LLMNov 7 2024

New research links blood pressure treatment to anxiety in women and reduced vitality in men, calling for personalized mental health support.

​​​​​​​Study: Blood pressure status, quality of life, and emotional states in adults with different disease awareness and treatment adherence. Image Credit: fizkes/Shutterstock.com

In a recent study published in the journal Nature Communications, researchers examined associations between blood pressure and health outcomes (both physiological and mental) among Iranian adults.

Introduction

The study used data from over 7,257 participants from the Tehran Lipid and Glucose Study (TLGS) cohort, collected during 2014-2017. Regression models revealed that physical health-related quality of life (HRQoL) was inversely associated with treatment adherence across both men and women.

In contrast, mental HRQoL outcomes showed distinct differences by sex. Among men with high blood pressure (BP) and high treatment adherence, only vitality was negatively impacted.

However, outcomes in women were more complex: those with high adherence to anti-hypertensive treatment had elevated anxiety, while those not adhering to treatment faced increased depression and stress.

Summary

The study emphasizes the need for psychiatric support for hypertensive patients and highlights the importance of personalized treatment approaches to improve HRQoL outcomes.

Background

Hypertension, or excessive blood pressure, is a chronic disease characterized by persistently high blood flow force within the arteries. It is estimated to be responsible for over 8.5 million deaths annually through direct or indirect associations with other health conditions. Rates of hypertension are rising globally, especially in Middle Eastern and underdeveloped nations.

Despite the increasing prevalence of hypertension, awareness and control remain low. In Iran, around 37% of adults are estimated to have hypertension, but less than half of this group (42%) have received a diagnosis, and an even smaller subset consistently adheres to treatment.

“Hypertension is a complex condition with significant impacts on an individual’s physical and mental health,” the researchers noted. This highlights the need for a multifaceted treatment approach, including lifestyle changes, medication, and regular monitoring to manage the physiological, metabolic, and psychological challenges associated with the condition.

The study was also informed by the ‘Biopsychosocial Model of Health and Disease’ (George Engel, 1977), which posits that biological, psychological, and social factors interact to influence health outcomes in chronic conditions like hypertension. Prior research has often focused on Western populations, leaving gaps in our understanding of HRQoL outcomes for Middle Eastern patients with hypertension.

Study details

This study aimed to address existing knowledge gaps by examining how varying levels of blood pressure and treatment adherence impact HRQoL and emotional states in an Iranian cohort.

It also examined the roles of sex, disease awareness, and treatment adherence in shaping health outcomes, with the goal of informing public healthcare strategies for improving the quality of life in hypertensive individuals.

Data was gathered from a subset of the TLGS cohort consisting of 7,941 adults, of whom 7,257 had complete data on demographics, socioeconomic factors, HRQoL, and medical history.

Hypertension was defined based on the Joint National Committee (JNC-VII) guidelines as either a systolic BP of ≥140 mmHg, a diastolic BP of ≥90 mmHg, or ongoing anti-hypertensive treatment.

Participants were categorized into four groups:

• Normotensive (no hypertension)
• Undiagnosed hypertension
• Diagnosed hypertension with treatment adherence
• Diagnosed hypertension without treatment adherence

Emotional health was measured using the Persian version of the Depression, Anxiety, and Stress Scale (DASS-21), while HRQoL was assessed with the Persian version of the 12-item Short Form Health Survey (SF-12v2). Statistical analysis used linear and logistic regression models adjusted for sex, demographics, and hypertension status.

Findings

Among the study’s participants, 54.4% were women with an average age of 47 years. Women had a higher average BMI and a greater prevalence of chronic diseases (54%) than men (40%).

Although the majority of both sexes were normotensive (78.3% of women and 75.7% of men), hypertension was slightly more prevalent in women (17%) than in men (14.7%).

The study found that individuals with undiagnosed hypertension did not show impaired HRQoL or emotional issues. Interestingly, high adherence to anti-hypertensive treatment was associated with significantly reduced HRQoL and emotional well-being in both sexes.

Sex-specific analysis revealed that men’s emotional health was unaffected by BP levels. Conversely, hypertensive women on anti-hypertensive medication experienced heightened anxiety, while those not adhering to medication showed higher levels of depression and stress.

Conclusion

This study sheds light on the complex relationships between hypertension, HRQoL, and emotional states, particularly the impacts of treatment adherence on quality of life. For both sexes, adherence to anti-hypertensive medication was linked to lower HRQoL scores.

Men appeared less affected by BP levels in terms of mental health, while hypertensive women exhibited elevated anxiety (if treatment-adherent) or increased depression and stress (if non-adherent).

The findings underscore the importance of psychiatric support and personalized treatment plans to support HRQoL and mental well-being in hypertensive patients.