Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109-2800, USA.
J Hypertens. 2012 Dec;30(12):2293-8. doi: 10.1097/HJH.0b013e328359b6e6.
Hypertension management requires detection (i.e. confirmation of persistently high blood pressure (BP) after an initial elevated measurement) and recognition of the condition (evidenced by a formal diagnosis and/or initiation of treatment). Our objective was to determine whether disparities exist in detection of elevated BP and recognition (i.e. diagnosis or treatment) of hypertension in patients with depression and anxiety.
Using data from the Cardiovascular Research Network Hypertension Registry, we assessed time-to-detection of elevated BP and recognition of hypertension in patients with comorbid anxiety and depression compared with patients with neither disorder. We performed multivariable survival analysis of time to detection and recognition in patients who entered the registry in 2002-2006. We adjusted for primary care visit rate and other relevant clinical factors.
In 168,630 incident hypertension patients, detection occurred earlier among patients with anxiety and depression compared with patients without these diagnoses [adjusted hazard ratio for anxiety and depression 1.30, 95% confidence interval (CI) 1.26-1.35]. Recognition of hypertension within 12 months of the second elevated BP was similar (adjusted hazard ratio for anxiety and depression 0.94, 95% CI 0.89-1.00) or delayed (adjusted hazard ratio for anxiety 0.93, 95% CI 0.88-0.99 and for depression 0.93, 95% CI 0.90-0.97).
Detection of elevated BP occurred earlier in patients with anxiety and depression. Time from detection to diagnosis or treatment was similar or delayed in patients with and without these diagnoses. Our findings suggest that as-yet-unidentified factors contribute to disparities in hypertension detection and recognition.
高血压管理需要检测（即，在初始升高的测量后确认持续的高血压（BP））和识别该病症（通过正式诊断和/或治疗开始证明）。我们的目的是确定在患有抑郁和焦虑的患者中是否存在 BP 升高的检测和识别（即诊断或治疗）方面的差异。
使用心血管研究网络高血压登记处的数据，我们评估了患有焦虑和抑郁共病的患者与没有这些疾病的患者相比，BP 升高的检测和高血压的识别（即诊断或治疗）的时间差异。我们对 2002-2006 年登记处入组的患者进行了多变量生存分析，以评估检测和识别的时间。我们调整了初级保健就诊率和其他相关临床因素。
在 168630 例新发高血压患者中，患有焦虑和抑郁的患者比没有这些诊断的患者更早发现 BP 升高（焦虑和抑郁的调整后危险比为 1.30，95%置信区间（CI）为 1.26-1.35）。在第二次 BP 升高后 12 个月内识别高血压的情况相似（焦虑和抑郁的调整后危险比为 0.94，95%CI 为 0.89-1.00）或延迟（焦虑的调整后危险比为 0.93，95%CI 为 0.88-0.99，抑郁的调整后危险比为 0.93，95%CI 为 0.90-0.97）。
患有焦虑和抑郁的患者中 BP 升高的检测更早。从检测到诊断或治疗的时间在有和没有这些诊断的患者中相似或延迟。我们的研究结果表明，仍有待确定的因素导致高血压检测和识别方面的差异。
