The impact of currently recommended antihypertensive therapy on depression and other psychometric parameters: preliminary communication.

AIMS: Current evidence on the psychological effects of antihypertensive medications is controversial. The aim of this study was to evaluate the effect of current antihypertensive medication on different psychometric parameters and on serum brain-derived neurotrophic factor (BDNF) level. METHODS: Psychometric, haemodynamic, arterial stiffness and laboratory parameters were evaluated before and 3 months after the initiation of antihypertensive medication in untreated hypertensive patients (HT, n=31), and once in healthy controls (CONT, n=22). Subjects completed the following psychometric tests: Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A), Symptom Checklist 90 Revised (SCL-90), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Big Five Inventory, Pain Vigilance and Awareness Questionnaire and Berkeley Expressivity Questionnaire. Amlodipine and/or perindopril compounds were preferred medications. Serum BDNF was measured with ELISA. RESULTS: Brachial systolic blood pressure, as well as pulse wave velocity were significantly improved in the HT group over the 3-month follow-up (153.3+/-15.9 mmHg vs. 129.5+/-10.0 mmHg and 8.2+/-1.4 m/s vs 7.5+/-1.6 m/s, respectively). Similarly, we found improvements in BDI (0.73 points) and in several Scl-90 subscales. Serum BDNF was not different between CONT and HT and did not change for therapy. CONCLUSIONS: Our results indicate that initiation of currently recommended antihypertensive medications in newly diagnosed patients may have a significant impact on psychological well-being of patients and could influence quality of life as well

Az affektív temperamentumok vizsgálata egészségesekben és különböző fenotípusú hypertoniás kórállapotokban = Evaluation of affective temperaments in healthy controls and in different hypertension phenotypes

Az affektív temperamentumok (depresszív, szorongó, ciklotím, hipertím, ingerlékeny) a személyiség olyan genetikailag meghatározott, felnőttkorban stabil részei, amelyekkel jellemezhetők a környezeti ingerekre adott érzelmi válaszok. Szerepük a pszichopatológiában elfogadott, de jelentőségüket a cardiovascularis betegségekben is egyre több adat támasztja alá. Célunk az volt, hogy értékeljük az affektív temperamentum pontszámokat egészséges egyénekben (Kont), fehérköpeny-hypertoniásokban (FkHT), krónikus nem rezisztens hypertoniásokban (KrónHT) és krónikus rezisztens hypertoniásokban (RezHT). Vizsgálatunkba 363 beteget vontunk be (n=Kont: 82; FkHT: 44; KrónHT: 200; RezHT: 37). A temperamentumok felmérésére a páciensek kitöltötték a Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire kérdőívet. A ciklotím affektív temperamentum pontszám magasabb volt a RezHTcsoportban (4 [2,25–8]) a Kont (2 [0–5]) és a KrónHT (3 [1–5]) csoporthoz képest (p<0,05). A ciklotím affektív temperamentum pontszám magasabb volt az FkHTcsoportban is (4 [2–7]) a Kontsoporthoz képest. A rezisztens hypertonia független kapcsolatban állt a ciklotím pontszám 6 vagy afeletti (béta=2,59 [95%-os CI: 1,16–5,77]), az ingerlékeny pontszám 7 vagy afeletti (béta=3,17 [95%-os CI: 1,3–7,69]) és a szorongó pontszám 9 vagy afeletti (béta=2,57 [95%-os CI: 1,08–6,13]) értékével. A fehérköpeny-hypertonia is független kapcsolatot mutatott a ciklotím pontszám 6 vagy afeletti értékével (béta=2,378 [95%-os CI: 1,178–4,802]). Következésképpen a fehérköpeny- és rezisztens hypertoniás csoportba tartozó betegek speciális affektív temperamentum mintázattal rendelkeznek és ezen mintázat megállapítása segíthet az ezekre a kórképekre hajlamos egyének azonosításában és a célzott prevencióban. = Affective temperaments (depressive, anxious, irritable, hyperthymic and cyclothymic) are stable parts of personality and describe the emotional reactivity for external stimuli. Their relation to psychopathological conditions is obvious, and increasing amount of data is available in cardiovascular disorders. The aim of this study was to evaluate affective temperaments in healthy subjects (Cont), in white-coat hypertensive (WhHT), in non-resistant (non-ResHT) and in resistant hypertensive (ResHT) patients. In this cross-sectional study, 363 patients were included: 82 Cont, 44 WhHT, 200 non-ResHT and 37 ResHT. The patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). In ResHT cyclothymic affective temperament points (4 [2.25–8]) were higher (p<0.05) compared with Cont (2 [0–5]) and with non-ResHT (3 [1–5]). Cyclothymic temperament points of WhHT (4 [2–7]) were also higher compared with Cont. ResHT was independently associated with cyclothymic scale equal or above 6 (Beta=2.59 [95% CI: 1.16–5.77]), irritable scale equal or above 7 (Beta=3.17 [95% CI: 1.3–7.69]) and anxious scale equal or above 9 (Beta=2.57 [95% CI: 1.08–6.13]) points. WhHT was also independently associated with cyclothymic scale equal or above 6 points (Beta= 2.378 [95% CI: 1.178–4.802]). In conclusions, white-coat and resistant hypertensive patients have specific affective temperament patterns, and their evaluation can help to understand the psychopathological background of these conditions

Association of affective temperaments with blood pressure and arterial stiffness in hypertensive patients: a cross-sectional study

BACKGROUND: Affective temperaments (anxious, depressive, cyclothymic, irritable and hyperthymic) measure subclinical manifestations of major mood disorders. Furthermore, cumulating evidence suggests their involvement in somatic disorders as well. We aimed to assess associations between affective temperament scores and blood pressure and arterial stiffness parameters in hypertensive patients. METHODS: In this cross-sectional study, 173 patients with well-controlled or grade 1 chronic hypertension, with no history of depression, completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Scale (HAM-A) questionnaires in three GP practices. Arterial stiffness was measured with tonometry (PulsePen). RESULTS: According to multiple linear regression analysis, cyclothymic temperament score was positively associated with brachial systolic blood pressure independently of age, sex, total cholesterol, brachial diastolic blood pressure, BDI, HAM-A and the use of alprazolam (beta = 0.529, p = 0.042), while hyperthymic temperament score was negatively related to augmentation index independent of age, sex, smoking, heart rate, BDI, HAM-A and the use of alprazolam (beta = -0.612, p = 0.013). A significant interaction was found between cyclothymic temperament score and sex in predicting brachial systolic blood pressure (p = 0.025), between irritable and anxious temperament scores and sex in predicting pulse wave velocity (p = 0.021, p = 0.023, respectively) and an interaction with borderline significance between hyperthymic temperament score and sex in predicting augmentation index (p = 0.052). CONCLUSIONS: The present findings highlight elevated blood pressure among subjects with high cyclothymic temperament as well as an increased level of arterial stiffening in subjects with low hyperthymic scores suggesting that affective temperaments may play a role in the development of hypertension and arterial stiffening and may thus represent markers of cardiovascular risk. Sex differences were also present in these associations

Hyperthymic affective temperament and hypertension are independent determinants of serum brain-derived neurotrophic factor level

BACKGROUND: Brain-derived neurotrophic factor (BDNF) has neuroprotective, proangiogenic and myogenic effects and, therefore, possibly acts as a psychosomatic mediator. Here, we measured serum BDNF (seBDNF) level in hypertensive patients (HT) and healthy controls (CONT) and its relation to affective temperaments, depression and anxiety scales, and arterial stiffness parameters. METHODS: In this cross-sectional study, affective temperaments, anxiety, and depression were studied with questionnaires (TEMPS-A, HAM-A, and BDI, respectively). SeBDNF level and routine laboratory parameters were measured as well. Arterial stiffness was evaluated with a tonometric method. RESULTS: Allover, 151 HT, and 32 CONT subjects were involved in the study. SeBDNF level was significantly higher in HT compared to CONT (24880 +/- 8279 vs 21202.6 +/- 6045.5 pg/mL, p < 0.05). In the final model of regression analysis, hyperthymic temperament score (Beta = 405.8, p = 0.004) and the presence of hypertension (Beta = 6121.2, p = 0.001) were independent determinants of seBDNF. In interaction analysis, it was found that in HT, a unit increase in hyperthymic score was associated with a 533.3 (95 %CI 241.3-825.3) pg/mL higher seBDNF. This interaction was missing in CONT. CONCLUSIONS: Our results suggest a complex psychosomatic involvement of BDNF in the pathophysiology of hypertension, where hyperthymic affective temperament may have a protective role. BDNF is not likely to have an effect on large arteries

Az affektív temperamentumok és az artériás érfalmerevségi index kapcsolata krónikus hypertoniás betegekben

Bevezetés: Az affektív temperamentumok (depresszív, cyclothym, hyperthym, ingerlékeny, szorongó) a személyiség- nek olyan genetikailag meghatározott, felnőttkorban stabil részei, amelyekkel jellemezhetők a környezeti ingerekre adott érzelmi válaszok. Az artériás érfalmerevségi index megmutatja, hogy az adott egyénnek a valóságban mért és az elvárt pulzushullám-terjedési sebessége (PWV) milyen arányban áll egymással; pozitív értéke számít kórosnak. Célkitűzés: Célunk az volt, hogy az affektív temperamentumok kapcsolatát vizsgáljuk az artériás érfalmerevségi index- szel krónikus hypertoniás betegekben. Módszer: A bevont betegeknél tonometriás eszközzel (PulsePen) mértük a carotis–femoralis PWV-t, mely az artériás érfalmerevség legelfogadottabb markere. Az artériás érfalmerevségi indexet a mért és az elvárt PWV arányában határoztuk meg. Az affektív temperamentumokat a Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire kérdőív (TEMPS-A) segítségével objektivizáltuk. Eredmények: Vizsgálatunkba 185 beteget vontunk be, életkoruk 61,6 (49,5–69,8) év volt. Kortól, nemtől, diabetes- től, alkoholfogyasztástól, dohányzástól, BMI-től, systolés vérnyomástól, összkoleszterinszinttől és GFR-től független kapcsolatot találtunk az artériás érfalmerevségi index és a depresszív (B = 0,009, 95% CI: 0,002–0,017, p = 0,018), a cyclothym (B = 0,009, 95% CI: 0,002–0,016, p = 0,012), az ingerlékeny (B = 0,013, 95% CI: 0,005–0,021, p<0,001) és a szorongó (B = 0,008, 95% CI: 0,003–0,013, p<0,001) temperamentum között. Következtetés: Újabb kapcsolatot sikerült kimutatni egy cardiovascularis rizikót jelző paraméter és az affektív temperamentumok között, ami megerősíti ezen személyiségjegyek meghatározásának jelentőségét cardiovascularis prevenciós szempontból is az ismert pszichopatológiai vonatkozások mellett