title: Anxiety sensitivity and medication nonadherence in patients with uncontrolled hypertension.
abstract: OBJECTIVE
  Anxiety sensitivity-fear of the negative social, physical, or cognitive consequences of anxiety related sensations-has been linked to cardiovascular disease and adverse cardiovascular health behaviors. Medication nonadherence may account for this association. We examined whether anxiety sensitivity was independently associated with objectively measured medication nonadherence in a multi-ethnic primary care sample.
  
  
  METHODS
  Eighty-eight patients with uncontrolled hypertension completed the Anxiety Sensitivity Index and had their adherence to blood pressure (BP) medications measured during the interval between two primary care visits using an electronic pillbox (MedSignals®). Multivariable Poisson regressions were conducted to determine the relative risks of medication nonadherence associated with anxiety sensitivity after adjustment for age, gender, Hispanic/Latino ethnicity, education, total number of prescribed medications, and depressive and posttraumatic stress disorder (PTSD) symptoms.
  
  
  RESULTS
  Nearly twice as many patients with high anxiety sensitivity were nonadherent to BP medications compared to patients with low anxiety sensitivity (65.0% vs. 36.8%; p=0.03). Patients with high anxiety sensitivity had higher relative risks of medication nonadherence than their low anxiety sensitivity counterparts (adjusted relative risk [RR]=1.76; 95% CI: 1.03-3.03).
  
  
  CONCLUSIONS
  In this first study of the association between anxiety sensitivity and medication adherence, we found that high anxiety sensitivity was strongly associated with BP medication nonadherence, even after adjustment for known confounders. Our results suggest that teaching patients who have uncontrolled hypertension adaptive strategies to manage their anxiety sensitivity may help improve their medication adherence, and thereby lower their cardiovascular risk.
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States. Electronic address: ca2543@columbia.edu.
authors.forename: Carmela
authors.initials: C
authors.lastname: Alcántara
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Moise
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Desiree
authors.initials: D
authors.lastname: Oyola
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: David
authors.initials: D
authors.lastname: Hiti
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001007:Anxiety; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology
chemical_list: D000959:Antihypertensive Agents
keywords: Anxiety; Cardiovascular disease risk factors; Hypertension; Medication