[Essential arterial hypertension: psychopathology, compliance, and quality of life]

To evaluate the influence of psychological and psychopathological factors and quality of life on hypertension, its treatment and patient compliance.

Case-control study.

Primary Health Care Center in Oporto.

Forty nine patients (pts) with essential hypertension (HT), 35 female and 14 male, mean ages: 52 +/- 11 yrs and 59 +/- 10 yrs, respectively, and 39 normotensive controls (NT)--18 female and 21 male, mean ages: 37 +/- 15 yrs and 42 +/- 15 yrs, respectively, were recruited from the same General Practice.

Hypertension was classified according to the Joint National Committee criteria. The following psychometric evaluations were used: the Beck Depression Inventory, the Hopkins Symptom Distress Checklist, the Psychological General Well-Being Schedule and the Eysenck Personality Inventory.

1. The hypertensive pts differed from the normotensive pts as they scored significantly higher in somatization (p = 0.07), aggression/hostility (p = 0.036), index of psychological distress (p = 0.08) and, neuroticism (p = 0.09); 2. the hypertensive pts showed lower scores of quality of life (p = 0.019); 3. the biochemical parameters studied (uric acid, urea, creatinine, glicose, total cholesterol, HDL cholesterol, trigliceride, transaminases and gammaglutamil transferase) did not show statistically significant correlation with the psychological variables and quality of life items studied; 4. the electrocardiographic and echocardiographic alterations, corresponding to the severity of the clinical situation, were not associated with statistically significant differences in depression and quality of life; 5. the angiotensin converting enzyme inhibitor, the calcium antagonist and the beta-blockers showed no statistically significant influence on the psychological scores studied. However, pts receiving diuretics showed higher scores of somatization (p = 0.0008) and obsession/ compulsion (p = 0.02) and, lower scores of quality of life (p = 0.04); 6. a better compliance was associated with better psychological scores, and somatization scored with statistical significance (p = 0.03).

The hypertensive pts differed from the normotensive pts as they scored significantly higher in aggression/hostility and lower in quality of life. No statistically significant differences were found among the psychological variables in the pts with cardiac involvement. A better compliance was associated with better psychological scores. The results of this study lead us to suggest that when treating pts with HT, the most appropriate therapeutic attitude should attempt to avoid both therapeutic withdrawal and lack of medical control.