title: Obsessive-Compulsive and Post Traumatic Avoidance Symptoms Influence the Response to Antihypertensive Therapy: Relevance in Uncontrolled Hypertension.
abstract: OBJECTIVE
  To investigate the association of uncontrolled hypertension with psychological factors associated with high cardiovascular morbidity and mortality (type D personality, depression, posttraumatic stress-related symptoms).
  
  
  METHODS
  205 consecutive outpatient hypertensives completed three questionnaires evaluating Type D personality (DS 16), post traumatic symptoms (revised Impact of Events Scale), symptoms of anxiety, hostility, depression and obsessive-compulsive traits (subscales of the Symptom Checklist). Uncontrolled hypertension was diagnosed when clinic sitting blood pressure was above 140/90 mmHg (130/80 in the presence of diabetes or nephropathy), despite reported adherence to treatment with at least three antihypertensive medications, including a diuretic.
  
  
  RESULTS
  Uncontrolled hypertension (39%), was predicted by lower scores at Symptom Checklist obsessive-compulsive subscale and higher number of post traumatic avoidance symptoms, older age, diabetes, higher systolic pressure at first visit and longstanding hypertension. Type D personality correlated with depression, hostility, anxiety, compulsiveness, history of malignancy, and older age, but not with uncontrolled hypertension.
  
  
  CONCLUSIONS
  Uncontrolled hypertension is associated with low obsessionality and avoidance symptoms, which reduce compliance to treatment. On the contrary, type D personality is not correlated with uncontrolled hypertension, as it includes compulsiveness, which improves compliance. A multidisciplinary approach to the hypertensive patient is mandatory to establish if the psychological profile affects compliance.
authors.affiliation: Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. anna.realdi@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Realdi
authors.affiliation: Psychiatric Clinic, Department of Neuroscience, University of Padua, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. angela.favaro@unipd.it.
authors.forename: Angela
authors.initials: A
authors.lastname: Favaro
authors.affiliation: Psychiatric Clinic, Department of Neuroscience, University of Padua, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. paolo.santonastaso@unipd.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Santonastaso
authors.affiliation: Psychiatric Clinic, Department of Neuroscience, University of Padua, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. marco.nuti@unipd.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Nuti
authors.affiliation: Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. emanuela.parotto@unipd.it.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Parotto
authors.affiliation: Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. giulia.inverso@unipd.it.
authors.forename: Giulia
authors.initials: G
authors.lastname: Inverso
authors.affiliation: Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. matteo.leoni@libero.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Leoni
authors.affiliation: Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. luisa.macchini@unipd.it.
authors.forename: Luisa
authors.initials: L
authors.lastname: Macchini
authors.affiliation: Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. francesca.vettore@unipd.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vettore
authors.affiliation: Clinica Medica 4, Department of Clinical and Experimental Medicine, Policlinico Universitario, Via Giustiniani 2 35128 Padova, Italy. renzcalo@unipd.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Calo
authors.affiliation: Division of General Medicine, SS. Giovanni e Paolo Hospital, Campo SS. Giovanni e Paolo, Castello 6777-30122 Venezia, Italy. andrea.semplicini@ulss12.ve.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Semplicini
keywords: avoidance symptoms; compliance; obsessive-compulsive symptoms; type D personality; uncontrolled hypertension