title: Patients with treatment-resistant hypertension report increased stress and anxiety: a worldwide study.
abstract: OBJECTIVE
  Treatment-resistant hypertension (rHTN) is defined as blood pressure (BP) that remains above goal despite compliance with at least three antihypertensive medications including a diuretic all at maximum tolerated doses or BP controlled on at least four drugs. An increased risk for cardiovascular events is associated with rHTN compared with controlled hypertension (HTN). The purpose of this study was to assess the emotional impact of rHTN on patients compared with the impact of uncontrolled hypertension (uHTN).
  
  
  METHODS
  We conducted an online survey in an international cohort of 2649 patients with uHTN and 1925 patients with rHTN. Adults self-reported as having uHTN or rHTN in eight countries (Brazil, France, Germany, Italy, Japan, Spain, United Kingdom, and United States) responded to a series of questions about their perceptions regarding the impact of HTN on their lives. The raw data were weighted by demographic variables, the propensity for respondents to be online (except data from Brazil and Japan), and the relative population of each country surveyed.
  
  
  RESULTS
  Respondents from both groups reported a substantial emotional impact from HTN. People with rHTN reported consistently greater impact than patients with uHTN, including a poorer perception of their overall health, greater degree of concern over their elevated BP, and a greater impact on their everyday lives.
  
  
  CONCLUSIONS
  In addition to the known risks to physical health, rHTN presents a substantial emotional burden to patients. An awareness of the emotional consequences of rHTN may help healthcare providers to communicate more effectively with their patients and, ultimately, to provide better care.
authors.affiliation: Department of Nephrology and Hypertension of the University Hospital, Erlangen, Germany. roland.schmieder@ukerlangen.de
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
mesh_terms: D000328:Adult; D001007:Anxiety; D005260:Female; D006801:Humans; D006973:Hypertension / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological