Association of Depression and Anxiety With Hypertensive Crisis. A Cross Sectional Study From a Hospital Setting in Karachi, Pakistan

Abstract

Objective: Hypertension, a leading risk factor for cardiovascular death has been closely linked with depression and anxiety. The aim of this study was to examine the association of depression or anxiety with hypertensive crisis in patients from a hospital setting and also see if the association is affected by age groups or gender. Design and method: This cross-sectional study was conducted between July 2019 and March 2022 on 290 patients admitted at the Aga Khan University Hospital (AKUH). All adult patients of more than 18 years of age admitted with uncontrolled hypertension with systolic blood pressure of > 140 and diastolic blood pressure > 90 admitted through emergency were included. Hypertensive crisis was defined as systolic blood pressure more than 180mm Hg or a diastolic blood pressure more than or equal to 120mm Hg, with or without accompanying end organ damage. Depression and Anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS), with a cut-off score of greater than 8. Results: Of the patients identified with uncontrolled hypertension, a total of 140 (48.3 percent) of the patients presented with a hypertensive crisis, while 150 (51.3 percent) did not have a hypertensive crisis at presentation. In the hypertensive crisis group, 60 (49. percent) had HADS scores consistent with depression, while 83 (59.3 percent) had HADS scores consistent with anxiety. In patients with hypertensive crisis, HADS depression and anxiety were most prevalent in the 61-75 age group (39.7 percent). In the comparison of gender, it was found that males and females with hypertensive crisis had an almost equal prevalence of anxiety (49.4 percent in males versus 50.6 percent in females). A slightly higher prevalence of depression was seen in females with hypertensive crises when compared to males. Conclusions: We found no association between depression or anxiety with hypertensive crisis, and the association is not affected by age group or gender. However, do note that half of the patients with hypertensive crises had depression or anxiety. Future large multicentered studies are required to study the link in greater detail.