title: Detection and recognition of hypertension in anxious and depressed patients.
abstract: OBJECTIVE
  Hypertension management requires detection (i.e. confirmation of persistently high blood pressure (BP) after an initial elevated measurement) and recognition of the condition (evidenced by a formal diagnosis and/or initiation of treatment). Our objective was to determine whether disparities exist in detection of elevated BP and recognition (i.e. diagnosis or treatment) of hypertension in patients with depression and anxiety.
  
  
  METHODS
  Using data from the Cardiovascular Research Network Hypertension Registry, we assessed time-to-detection of elevated BP and recognition of hypertension in patients with comorbid anxiety and depression compared with patients with neither disorder. We performed multivariable survival analysis of time to detection and recognition in patients who entered the registry in 2002-2006. We adjusted for primary care visit rate and other relevant clinical factors.
  
  
  RESULTS
  In 168,630 incident hypertension patients, detection occurred earlier among patients with anxiety and depression compared with patients without these diagnoses [adjusted hazard ratio for anxiety and depression 1.30, 95% confidence interval (CI) 1.26-1.35]. Recognition of hypertension within 12 months of the second elevated BP was similar (adjusted hazard ratio for anxiety and depression 0.94, 95% CI 0.89-1.00) or delayed (adjusted hazard ratio for anxiety 0.93, 95% CI 0.88-0.99 and for depression 0.93, 95% CI 0.90-0.97).
  
  
  CONCLUSIONS
  Detection of elevated BP occurred earlier in patients with anxiety and depression. Time from detection to diagnosis or treatment was similar or delayed in patients with and without these diagnoses. Our findings suggest that as-yet-unidentified factors contribute to disparities in hypertension detection and recognition.
authors.affiliation: Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109-2800, USA. jbbyrd@umich.edu
authors.forename: James B
authors.initials: JB
authors.lastname: Byrd
authors.forename: J David
authors.initials: JD
authors.lastname: Powers
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Heather M
authors.initials: HM
authors.lastname: Tavel
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Arne L
authors.initials: AL
authors.lastname: Beck
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.forename: Pei-Jai M
authors.initials: PJ
authors.lastname: Ho
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001007:Anxiety / Q000453:epidemiology*; D001794:Blood Pressure / Q000502:physiology; D015897:Comorbidity; D057210:Delayed Diagnosis; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012042:Registries; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents