PANIC DISORDER, ANXIETY AND DEPRESSION IN RESISTANT HYPERTENSION - A CASE-CONTROL STUDY

Background it has been suggested that panic disorder can cause or cont ribute to hypertension or resistance to antihypertensive drugs, Object ive To compare the prevalences of panic disorder, panic attacks, anxie ty and depression between patients with resistant hypertension and age -and sex-matched patients with non-resistant hypertension. Design A ca se-control study of patients attending the Sheffield Hypertension Clin ic, using self-completed postal questionnaires to assess panic disorde r, anxiety and depression. Patients Cases with resistant hypertension were defined as patients who presently or previously had systolic bloo d pressure above 160 mmHg or diastolic blood pressure above 90 mmHg de spite the use of three or more antihypertensive agents at full dose. F or each of 136 cases, one control with non-resistant hypertension, def ined as controlled to less than or equal to 160/90 mmHg by one or two antihypertensive agents, was identified by a bias-free method. Cases a nd controls were matched for age and sex. Main outcome measures Lifeti me and current prevalence of panic attacks, the prevalences of panic d isorder, anxiety and depression by Hospital Anxiety and Depression Sca le scores, and the severity and frequency of panic attacks, Results Of the resistant hypertensive patients, 33% had experienced a panic atta ck compared with 39% of the control non-resistant hypertensives (resis tant non-resistant -6%, 95% confidence interval -19 to +7%), Twelve pe r cent of the resistant patients and 14% of controls fulfilled the cri teria for a current or previous diagnosis of panic disorder (resistant -non-resistant -2%, 95% confidence interval -11 to +7%). There were a lso no significant differences between the groups in the prevalences o f current panic attacks, panic attacks rated as moderate or worse, spo ntaneous panic attacks and in the frequency of panic attacks. There re mained no significant difference between the groups for panic attacks and panic disorder when the analysis was limited to those patients who had idiopathic hypertension. The two groups did not differ significan tly in scores for anxiety and depression measured by the Hospital Anxi ety and Depression Scale. Conclusion We observed no differences in the prevalences of panic, anxiety and depression between patients with re sistant hypertension and non-resistant controls. These factors are pro bably not implicated in resistance to drug treatment, However, the pre valences of panic disorder and panic attacks were remarkably high in b oth groups of patients attending a hospital hypertension clinic, The r elationship between panic disorder and hypertension deserves further s tudy in a general hypertensive population.