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Hypertension

Mental Health and Hypertension: A Q&A With Dr Sylvia Rozario

Mental health and cardiovascular disease are leading causes of death and morbidity in the United States. As mental health takes a spotlight in the United States, it is more important than ever to highlight the associated comorbidities to better treat patients with concurrent diseases.

A new study examined the relationship between mental health status and the risk for hypertension among women.1 Consultant360 spoke with the lead author of the study, Sylvia Rozario, MPH, MBBS, who is a PhD student in the Department of Family Medicine and Community Health at Virginia Commonwealth University.

 

Consultant360: Can you tell us a little bit more about your study and how it came about?

Dr Sylvia Rozario: Mental health is still an under-investigated, under-diagnosed, and under-treated domain in the US health care system, although we know poor mental health has many adverse consequences. Mental health disorders, such as depression, are more prevalent among women than men.2 Further, poor mental health can be related to chronic stress in women,3 and chronic stress is a known risk factor for hypertension.4,5 Even though the prevalence of hypertension is similar in men and women,6 hypertensive outcomes such as mortality from cardiovascular diseases are worse in women than in men.7

Is there an association between mental health and hypertension in women? Are there any missed opportunities for screening of mental health disorders in health care settings? Can we utilize the existing health care systems that deal with hypertensive patients to increase the screening and diagnosis of mental health disorders without increasing the health care cost by much? These are some of the questions that gave rise to the hypothesis of our study. We then sought to determine whether poor mental health could be a risk factor for hypertension in women and, if so, what impact these 2 factors had on hospital inpatient visits.

 

C360: Which mental health conditions did you investigate in your analysis? And did each hold different levels of risk for hypertension?

SR: We did not investigate any specific mental health conditions in our analysis. Instead, we assessed the overall mental health status of a woman using a measure for non-specific psychological distress called the Kessler (K6) scale. The K6 scale is a widely used and validated summary measure of a person’s overall rating of their feelings during the past 30 days.8 The score is calculated based on the respondents’ answers to 6 mental-health–related questions assessing non-specific psychological distress (for example, felt nervous, felt hopeless, felt worthless). The total score ranges from 0 to 24; the higher the score, the greater the severity of psychological distress. We selected a cut point that has been used in previous studies to define poor mental health and good/excellent mental health status.

 

C360: Your study specifically examined this association in women. But do you think the association might affect men to some extent as well?

SR: Absolutely! In this study, we specifically examined women based on the fact that the prevalence of mental health disorders, chronic stress, hospital inpatient visits, and mortality associated with cardiovascular diseases are all higher in women compared with men. Subsequently, we conducted a follow-up study assessing gender differences in the association between mental health, hypertension, and emergency room visits and found that men with poor mental health also have a higher likelihood of being diagnosed with hypertension. However, our results showed that the strength of association between mental health and hypertension is stronger for women compared with men.

 

C360: What is your advice to clinicians who treat hypertension and mental health conditions in women? What is the main message you want to send to practitioners?

SR: This study found a significant association between poor mental health and hypertension in women. Women with poor mental health have a higher likelihood of being diagnosed with hypertension compared with women with good or excellent mental health. Since hypertension is already routinely screened in health care settings, we suggest concurrent screening of mental health disorders when a woman is diagnosed with hypertension.

Health professionals should focus on utilizing available screening tools to assess the mental health status of both men and women, targeting women more, for early detection and management of mental health disorders. Early detection and management of mental health disorders in association with hypertension could significantly reduce mental-health–related morbidities, hospitalizations, and associated costs. Practitioners should be aware of the significant association between poor mental health status and hypertension in women. Further, they should be aware of the fact that poor mental health status in combination with hypertension could be a strong predictor of hospital inpatient visits in women.

 

C360: What else should our audience of cardiologists and psychologists know about treating these conditions separately and concurrently?

SR: Since this study was cross-sectional in design, information for both mental health status and hypertension were obtained at the same time; we could not establish temporality of this relationship. From this study, we cannot say which one comes first—poor mental health conditions or hypertension; we cannot say for certain that poor mental health causes hypertension in women. Therefore, when treating these conditions separately, cardiologists should be aware of the increased risk of mental health disorders in women with hypertension. Similarly, psychologists should be aware of the increased risk of hypertension in women with mental health disorders. Moreover, both cardiologists and psychologists should be aware and cautious about the drug interactions and side effects of antihypertensive and psychiatric drugs when treating these conditions concurrently.

 

—Amanda Balbi

References:

  1. Rozario SS, Masho SW. The associations between mental health status, hypertension, and hospital inpatient visits in women in the United States. Am J Hypertension. 2018;31(7):804-810. https://doi.org/10.1093/ajh/hpy065.
  2. Ford DE, Erlinger TP. Depression and C-reactive protein in US adults: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2004; 164:1010-1014.
  3. Hange D, Mehlig K, Lissner L, et al. Perceived mental stress in women associated with psychosomatic symptoms, but not mortality: observations from the Population Study of Women in Gothenburg, Sweden. Int J Gen Med. 2013;6:307-315.
  4. Richardson S, Shaffer JA, Falzon L, Krupka D, Davidson KW, Edmondson D. Meta-analysis of perceived stress and its association with incident coronary heart disease. Am J Cardiol. 2012;110:1711-1716.
  5. Agyei B, Nicolaou M, Boateng L, Dijkshoorn H, van den Born BJ, Agyemang C. Relationship between psychosocial stress and hypertension among Ghanaians in Amsterdam, the Netherlands—the GHAIA study. BMC Public Health. 2014;14:692.
  6. Yoon SS, Fryar CD, Carroll MD. Hypertension prevalence and control among adults: United States, 2011–2014. NCHS Data Brief. 2015;220:1-8.
  7. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010;18:598-602.
  8. Prochaska JJ, Sung HY, Max W, Shi Y, Ong M. Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int J Methods Psychiatr Res. 2012;21:88-97.