Quality of life and Psychopathology in Essential Hypertension with

Διεπιστημονική Φροντίδα Υγείας(2014) Τόμος 6,Τεύχος 3, 128-136
ISSN 1791 - 9649
Quality of life and Psychopathology in Essential Hypertension with
Dyslipidaemia
Tsartsalis D.1, 2, Dragioti E.3, Kontoangelos K.4,5, Gouva M.3, Pitsavos C.2, Sakkas P.4, Papageorgiou C.4, Stefanadis
C.2, Kallikazaros I.1
1,2
MD, MSc, Cardiologist – Department of Cardiology, Hippokration Hospital, Athens, Greece, and 1st Department of Cardiology,
University of Athens, Medical School, Hippokration Hospital, Athens, Greece.
3
Psychologist, MSc, PhD,Research Laboratory Psychology of Patients, Families and Health Professionals - Higher Technological
Educational Institution of Epirus, Ioannina, Greece.
4,5
MD, PhD, Psychiatrist – 1st Department of Psychiatry, University of Athens, Medical School, Eginition University Hospital,
Athens, Greece, and University Mental Health Research Institute, Athens , Greece.
3
Associate Professor of Psychology -Research Laboratory Psychology of Patients, Families and Health Professionals - Higher
Technological Educational Institution of Epirus, Ioannina, Greece.
2
Professor of Cardiology - 1st Department of Cardiology, University of Athens, Medical School, Hippokration Hospital, Athens,
Greece.
4
Associate Professor of Psychiatry - 1st Department of Psychiatry, University of Athens, Medical School, Eginition University
Hospital, Athens, Greece.
4
Professor of Psychiatry,Department of Psychiatry, University of Athens, Medical School, Eginition University Hospital, Athens,
Greece
2
Professor of Cardiology, Head of 1st Department of Cardiology, University of Athens, Medical School, Hippokration Hospital,
Athens, Greece.
1
MD, PhD, Cardiologist, Head of Department of Cardiology, Hippokration Hospital, Athens, Greece.
ABSTRACT
Background:Patients with chronic conditions like hypertension may experience many negative emotions which
increase their risk for poor quality of lifeas well as the development of anxiety and depression symptomatology.
However little is known about hypertension accompanied by dyslipidaemia. Aim: This study aimed to investigate the
possible differences between hypertensive patients with dyslipidaemia and hypertensive patients without
dyslipidaemia on quality of life and mental health. Methods:One hundred and nineteen-seven patients with essential
hypertension participated and classified into two groups― dyslipidemic and non dyslipidaemic ― based on the levels
of hypertension and cholesterol after medical examination. Along with a questionnaire regarding demographics and
clinical features the SF-36 Health Survey, the Symptom Checklist-90-R, and the Cardiac Anxiety Questionnaire were
administered. Results: Lower levels of Physical Functioning (p=.001), Role –Physical (p=.046), Vitality (p=.000),
Bodily Pain (p=.004), General Health (p=.000) and Physical Component Summary (p=.000)betweendyslipidemic and
non dyslipidaemichypertensive patients were found. Significant differences between groups were also observed in all
dimensions of psychopathology with exception to Hostility (p=.097), and Phobic Anxiety (p=.472). Apart from the
avoidance subscale (p=.018), no difference onheart focused anxiety between the two groups was found. Logistic
regression model found that dyslipidaemic hypertensive patients had in general a higher risk of impairment regarding
quality of life and psychopathology. Conclusions: There is a significant association between presence of
dyslipidaemia and deteriorated quality of life as well as mental symptomatology inhypertensive patients. The need for
a more target therapeutic schema is outlined.
Key-words: essential hypertension • quality of life • psychopathology • dyslipidaemia •heart focused anxiety
Cor. Author: Gouva M. Tei of Epirus e-mail: [email protected]
128
Interscientific Health Care (2014) Vol 6, Issue 3, 128-136
ISSN 1791 - 9649
Ποιότητα ζωής και Ψυχοπαθολογία σε Ιδιοπαθή Υπέρταση με
Δυσλιπιδαιμία
Τσαρτσάλης Δ.1, 2, Δραγκιώτη Ε.3,Kοντοάγγελος Κ.4,5, Γκούβα Μ. 3, Πίτσαβος Χ.2, Σακκάς Π. 4, Παπαγεωργίου Χ.4,
Στεφανάδης Χ.2, Καλλικάζαρος Ι.1
1,2
MD, MSc, Καρδιολόγος – ΚαρδιολογικόΤμήμα, ΙπποκράτειοΝοσοκομείοΑθηνώνκαι
1ηΚαρδιολογική Κλινική, Πανεπιστήμιο
Αθηνών, Ιατρική Σχολή, Ιπποκράτειο Νοσοκομείο Αθηνών
3
Ψυχολόγος, MSc, PhD,Ερευνητικό Εργαστήριο Ψυχολογίας Ασθενών Οικογενειών και Επαγγελματιών Υγείας, Ανώτατο
Τεχνολογικό Εκπαιδευτικό Ίδρυμα Ηπείρου.
4,5
Ψυχίατρος,MD, PhD, 1ηΨυχιατρικήΚλινική, Πανεπιστήμιο Αθηνών, Ιατρική Σχολή, Αιγινήτειο Νοσοκομείο Αθηνών και Ερευνητικό
Πανεπιστημιακό Ινστιτούτο Ψυχικής Υγιεινής, Αθήνα.
3
ΑναπληρώτριαΚαθηγήτριαΨυχολογίας, Ερευνητικό Εργαστήριο Ψυχολογίας Ασθενών Οικογενειών και Επαγγελματιών Υγείας,
Ανώτατο Τεχνολογικό Εκπαιδευτικό Ίδρυμα Ηπείρου.
2
ΚαθηγητήςΚαρδιολογίας, 1η Καρδιολογική Κλινική, Πανεπιστήμιο Αθηνών, Ιατρική Σχολή, Ιπποκράτειο Νοσοκομείο Αθηνών.
4
ΑναπληρωτήςΚαθηγητήςΨυχιατρικής1η Ψυχιατρική Κλινική, Πανεπιστήμιο Αθηνών, Ιατρική Σχολή, Αιγινήτειο Νοσοκομείο
Αθηνών
4
Καθηγητής Ψυχιατρικής, 1η Ψυχιατρική Κλινική, Πανεπιστήμιο Αθηνών, Ιατρική Σχολή, Αιγινήτειο Νοσοκομείο Αθηνών
2
Καθηγητής Καρδιολογίας, 1η Καρδιολογική Κλινική, Πανεπιστήμιο Αθηνών, Ιατρική Σχολή, Ιπποκράτειο Νοσοκομείο Αθηνών
1
MD, PhD, Καρδιολόγος, ΣυντονιστήςΔιευθυντής Καρδιολογικό Τμήμα, Ιπποκράτειο Νοσοκομείο Αθηνών.
ΠΕΡΙΛΗΨΗ
Εισαγωγή: Ασθενείς με χρόνιες παθήσεις σαν την υπέρταση είναι δυνατό να βιώνουν αρκετά αρνητικά
συναισθήματα, τα οποία αυξάνουν τον κίνδυνο για φτωχή ποιότητα ζωής καθώς και την ανάπτυξη άγχους και
καταθλιπτικής συμπτωματολογίας.Παρόλα αυτά λίγα μας είναι γνωστά για την υπέρταση συνοδευόμενη με
δυσλιπιδαιμία. Σκοπός:Σκοπός της παρούσας μελέτης είναι η διερεύνηση των πιθανών διαφορών μεταξύ των
υπερτασικών ασθενών με ή χωρίς δυσλιπιδαιμία αναφορικά με την ποιότητα ζωής και την ψυχική υγεία.
Μέθοδος:Εκατόν ενενήντα επτά
ασθενείς με ιδιοπαθή υπέρταση συμμετείχαν στην παρούσα μελέτη και
ταξινομήθηκαν σε δύο ομάδες ― δυσλιπιδαιμικοί και μη δυσλιπιδαιμικοί― με βάση τα επίπεδα της αρτηριακής πίεσης
και της χοληστερίνης μετά από ιατρική εξέταση. Οι ασθενέις συμπλήρωσαν μαζί με ένα ερωτηματολόγιο
δημογραφικών και κλινικών παραμέτρων το ερωτηματολόγιο Επισκόπησης τη Υγείας SF-36, την Kλίμακα
Ψυχοπαθολογίας SCL-90-R, και την Κλίμακα μέτρησης άγχους για την καρδιακή λειτουργίαCAQ.
Αποτελέσματα:Χαμηλότερα επίπεδα σωματικής λειτουργικότητας (p=.001), σωματικού ρόλου (p=.046), ζωτικότητας
(p=.000), σωματικού πόνου (p=.004), γενικής υγείας (p=.000) και συνοπτικού δείκτη σωματικής υγείας (p=.000)
διαπιστώθηκαν μεταξύ υπερτασικών ασθενών με δυσλιπιδαιμία και υπερτασικών ασθενών χωρίς δυσλιπιδαιμία.
Επίσης, παρατηρήθηκαν στατιστικά σημαντικές διαφορές ανάμεσα στις δύο ομάδες όσον αφορά όλες τις διαστάσεις
της ψυχοπαθολογίας με εξαίρεση την επιθετικότητα (p=.097) και το φοβικό άγχος (p=.472). Εκτός από την διάστασης
της αποφυγής των δραστηριοτήτων που συνδέονται με την καρδιακή λειτουργία (p=.018), δεν διαπιστώθηκαν
διαφορές σε σχέση με το άγχος για την καρδιακή λειτουργία. Το μοντέλο της λογαριθμικής παλινδρόμησης ανέδειξε ότι
εν γένει, οι δυσλιπιδαιμικοί υπερτασικού ασθενείς έχουν αυξημένο κίνδυνο για επιβαρυμένη ποιότητα ζωής και ψυχική
υγεία. Συμπεράσματα: Τα αποτελέσματα υποστηρίζουν μια στατιστικά σημαντική διασύνδεση μεταξύ δυσλιπιδαιμίας
και ποιότητας ζωής, καθώς και με την ψυχοπαθολογία στο ευρύτερο πλαίσιο της ιδιοπαθούς υπέρτασης. Είναι
πρόδηλη η ανάγκη στοχευμένων θεραπευτικών παρεμβάσεων.
Λέξεις κλειδιά:ιδιοπαθής υπέρταση • ποιότητα ζωής • ψυχοπαθολογία • δυσλιπιδαιμία • άγχος για την καρδιακή
λειτουργία.
INTRODUCTION
Essential hypertension is a well-established major risk
factor contributing significantly to morbidity by causing
stroke, as well as cardiovascular and kidney disease
(He et al. 2005). It is estimated that at least 30% of
overall mortality worldwide is somehow associated
with hypertensive disease. The prevalence of
hypertension is already elevated and is expected to
rise further in the forthcoming years
(Kearney et al. 2004), magnifying proportionally the
burden in health systems (Mancia et al. 2013; WHO
2012).
Several studies have highlighted the significant
impact on the quality of life of patients with
hypertension (Barger et al. 2006; Gil et al. 2001). Both
disease’s complications and medication adverse
reactions are considered as the factors responsible to
Cor. Author: Gouva M. Tei of Epirus e-mail: [email protected]
129
this effect (Reibis et al. 2012; Krijnen et al. 2005).
Hypertensive patients tend to demonstrate declined
performance in various dimensions of HRQOL as in
general well-being, functional capacity and symptoms
of psychological distress (Trevisol et al. 2012; Khaw et
al. 2011; Ayalon et al. 2006; Erikson et al. 2001). Thus,
evidence support that deteriorated levels of healthrelated quality of life (HRQOL) implicate the
cardiovascular outcome in this group of patients
(Bardage&Isacson 2001). There is also a great
consideration regarding the role of psychological
factors in the cardiovascular spectrum (Frasure-Smith
et al. 1993; Rosengren et al 2004). As in other chronic
medical conditions, hypertensives experience many
profound emotions which attenuate their risk for the
development of psychological distress in terms of
anxiety
and
depression
(Krijnen
et
al.
2005;Bardage&Isacson 2001). Evidence underline
especially the close reciprocal link between
hypertension and depression. Depressive mood and
anxiety have been associated with increased rates of
hypertension whereas clinical diagnosis of depression
represents a potential risk factor leading to elevated
arterial blood pressure (Patten et al. 2009;Hildrum et
al. 2008). Therefore the modern therapeutics should
focus not only on symptom management, but also on
quality-of-life and mental health improvement
(Kokkinos et al. 2009).
Nevertheless, dyslipidaemia is also becoming a
common medical condition with increasing incidence.
As many as half of the adult population in the USA
have total cholesterol levels ≥ 200 mg/dl, while 2 out of
3 patients with cardiovascular disease (CVD) in
Europe have total cholesterol levels ≥190 mg/dl(Ford
et al. 2003).In this point of view,the evaluation of both
HRQL and psychopathology are provided to be
intriguing tasks in hypertensives patients with
dyslipidaemia, as these conditions often clash together
increasing the total cardiovascular risk and moreover
implicating negatively the physical, social and mental
domains that determine the patients’ overall well-being
and status (Perk et al. 2012; Catapano et al. 2011).As
a result, a therapeutic strategy focusing in
improvement of quality of life, could also offer
substantial improvement in the management of
patients suffering from hypertension anddyslipidaemia.
However less attention to the combination of these
factors has been devoted so far. Therefore the aim of
the present study was to measure HRQL and
psychopathology
in
patients
suffering
from
hypertension with and without dyslipidaemia, as well
as to compare them in order to explore possible
differences in their symptomatology.
METHODS
Subjects and procedures
We prospectively included 197 newly diagnosed
patients with essential hypertension. The patients were
recruited from an outpatient hypertension clinic at
Athens Hippokration University Hospital. Further
inclusion criteria were: age between 18 and 80 years.
Patients had not to be under optimized medical
therapy for hypertension before entering the study. All
patients underwent a detailed clinical work up
including a careful medical history further asking for
mental disorders, and additional laboratory testing
including blood and urine samples in order to evaluate
the presence of dyslipidaemia and identify other
accompanying cardiovascular risk factors and primitive
implications of hypertension. Cardiac and carotid
ultrasounds were implemented in all participants.
Diagnosis of hypertension was established
combining office and 24-hour ambulatory blood
pressure measurements according to 2007 ESC/ESH
guidelines. Dyslipidaemia was defined in terms of total
cholesterol (TL) >190 mg/dL (5.0 mmol/L) and/or low
density lipoprotein (LDL) cholesterol >115 mg/dL (3.0
mmol/L), and/or high density lipoprotein (HDL)
cholesterol <40 mg/dL (1.0 mmol/L) and/or high fasting
triglycerides >150 (1.7 mmol/L) at first examination
((Perk et al. 2012; Catapano et al. 2011). In a next
step, those 197 patients were assigned into two
groups on the basis of their measurements on
dyslipidaemiascores.The first group (dyslipidaemic
hypertensive patients) consisted of 121 patients and
the second group (non dyslipidaemic hypertensive
patients) consisted of 76 patients.
Exclusion criteria were as follows: having a
psychiatrist disorder or being under relevant treatment
for such disorder, secondary hypertension, cognitive
impairment, and/or being older than 80 years. All
patients gave written informed consent for this study,
which was approved by the Ethics Committee of the
University of Athens. Psychological measures were
scored by an expertise psychologist (E.D).
INSTRUMENTS
Quality of life
Quality of life was measured by using the multipurpose health survey Short Form-36 (SF-36)
questionnaire. The SF-36 is a self –reported
instrument consisting of only 36 questions (Ware et al.
1993). It yields an 8-scale profile of functional health
and well-being scores as well as psychometricallybased physical and mental health summary measures
and a preference-based health utility index. The score
of each dimension is the addition of the item scores of
the related dimension further transformed to a score of
0–100. The higher values representing better
perceived health-related quality of life (Mc Horney,
1994). It is a generic measure, as opposed to one that
targets a specific age, disease, or treatment group. It
has been standardized for the Greek population and
has been demonstrated to possess satisfactory
psychometric features for clinical and non-clinical
samples (Pappa et al. 2005).
Psychopathology
The Symptom Checklist-90–R (SCL-90–R; Derogatis,
1977) was selected to evaluate the convergent validity
ofthe Cardiac Anxiety Questionnaire. The SCL-90–R
was designed to assessa wide range of psychological
factors and symptoms of psychopathology.It consists
of 90 items that measure nine primary symptom
dimensions
(somatisation,
obsessive-compulsive
disorder, interpersonal sensitivity, depression, anxiety,
hostility, phobic anxiety, paranoid ideation, and
psychoticism).It is rated on a 5-point scale (0: Not at all
to 4: Extremely), indicating the frequency of
experiencing the symptoms described at a specific
point in time. The SCL-90–R is constructed to provide
Υπεύθ. Αλ/φίας: Γκούβα Μ. ΤΕΙ Ηπείρου e-mail: [email protected]
130
an overview of a patient’s symptoms and their intensity
by providing three global indices (Derogatis, 1993). It
has been standardized for the Greek population and
has satisfactory psychometric properties (Donias,
Karastergiou, & Manos,1991).
Cardiac anxiety
Heart focused anxiety (commonly referred to as
cardiophobia) was measured using the Greek version
of Cardiac Anxiety Questionnaire (CAQ) consists of 10
items (Dragioti et al. 2011). The initial instrument
(Eifert et al. 2000) consists of 18 items and 3
subscales: (a) Fear (8 items; e.g, “Even if tests come
out normal, I will still worry about my heart”); (b)
Avoidance (5 items; e.g, “I avoid physical exertion”);
and (c) Attention (5 items; e.g, “I pay attention to my
heartbeat”). A 5-point Likert-type scale, with anchors of
0: Never and 4: Always, was used to rate the
responses on each item. The CAQ -10 yields a total
score and scores for each above subscale. Values
close to 4 are representing more anxiety and cardiac
functioning concern (i.e. cardiophobia) (Eifert et al.
2000]. It has been standardized for the Greek
population and found to possess satisfactory
psychometric features. The stability of the
questionnaire was verified by a high test-retest
reliability over a 3-mo. period (r = .86). The test also
has high internal consistency (α=.80) (Dragioti et al.
2011).
Demographic characteristics and clinical features
Along with the measures described above the
participants completed a questionnaire regarding
socio-demographic information (e.g., age, gender,
marital status). Substantial clinical features werealso
recorded and evaluated by a specialist cardiologist
doctor (D.T) during a medical interview at hypertensive
unit.
Data Analyses
Distribution frequencies, means and standard
deviations were applied for the description of sample’s
social, demographic and psychological characteristics.
The parametric independent student T test was
adopted to compare dyslipidaemic hypertensive
patients,and non dyslipidaemic hypertensive patients’
scores on the quantitative variables, since their
distribution was symmetric. The criteria for testing
normality was:≥ ± 2,00 for the Skewness and ≥ ± 5,00
for the Kyrtosis (Skordilis&Stavrou, 2005). Pearson x2
(chi-square) tests was performed for the comparison of
categorical variables. As a final steplogistic regression
model was performed to investigate whether
dimensions of quality of life, psychopathology and
cardiac anxiety were independently associated with
dyslipidaemic hypertensive patients, regardless of
other possible covariate effects.
RESULTS
Demographic characteristics of the sample
Of the 1307 patients approached during a period of six
months, 314 were eligible for inclusion and invited to
participate in the study. One hundred and nineteenseven (62. 73 %; mean age) completed and returned
the questionnaires. The rest of them did not complete
fully the instruments or did not provide the consent to
participate in the study. Therefore the final sample was
consisted of 197 with a mean age of 53 years (SD = 12) at baseline. One hundred -eight (55.1%) patients
were females and the rest eighty-nine (44.9%) males.
The vast majority of the participants were married
(71.1%). The duration of essential hypertension was
27.5 months (SD = 40). Ninety-forty of the (47.7%)
participants suffered from essential grade I
hypertension; 68 (34.5%) were grade II; 16 (8.1%)
were categorized as grade III, while only 10 (5.1%)
patients
were
recorded
as
high
normal
(normotensives). Fullness mean standard deviations
and
distribution
frequencies
of
demographic
characteristics of the sample are represented in Table
1. Complete data were available also for the two
groups
(dyslipidaemic
vs
non
dyslipidaemichypertensive patients). Age (p=.004),
marital status (p=.008) and smoking (p=.012)werediffer
significantly between dyslipidaemic hypertensive
patients, and non dyslipidaemic hypertensive patients.
Comparisons between groups
The next step to our analysis was to compare the two
groups on the quantitative variables by means of t
tests. As shown in Table 2 the dyslipidaemia group
reported marginally lower levels of Physical
Functioning (p=.001), Role –Physical (p=.046), Vitality
(p=.000), Bodily Pain (p=.004), General Health
(p=.000) and Physical Component Summary (p=.000)
as measured by Short Form-36 (SF-36) questionnaire.
Significant differences between groups were also
observed on all dimensions of psychopathology as
measured by SCL-90-R with exception to Hostility
(p=.097), and Phobic Anxiety (p=.472). The groups
were not significantly different on the dimensions of
cardiac anxiety, except the Avoidance scale (p=.017).
Regression models for dyslipidaemic hypertensive
patients
To justify further investigation, models of logistic
regression, examining the associations among
dyslipidaemia, quality of life, psychopathology and
family environment, was performed. As shown in table
3, after controlling for socio-demographic and clinical
variables, dyslipidaemic hypertensive patients had a
higher risk of Role -Physical (OR=1.07, 95% CI=1.031.11), Vitality (OR=.94, 95% CI=.89-.98), Physical
Component Summary (OR=1.01, 95% CI=1.05-1.39),
Somatization
(OR=1.60,
95%
CI=1.242.07),Interpersonal
Sensitivity
(OR=1.37,
95%
CI=1.04-1.80), Anxiety (OR=.72, 95% CI=.53-.97),
Paranoid Ideation (OR=.72, 95% CI=.54-.95) and
Avoidance (OR=8.71, 95% CI=1.55-4.93).
DISCUSSION
We explored the differences in terms of dyslipidaemia
among hypertensive patients and we showed that
there
is
a
significant
association
between
dyslipidaemia and quality of life as well as mental
symptomatology in the context of hypertension.
Specifically, we found significantly lower levels in
dimensions of quality of life and higher levels almost in
all dimensions of psychopathology when hypertension
is accompanied by dyslipidaemia compared to patients
without dyslipidaemia. Large effect of avoidance of
activities believed to reproduce cardiac symptoms in
dyslipidaemic hypertensive patients was further
observed.
Cor. Author: Gouva M. Tei of Epirus e-mail: [email protected]
131
Several studies have outlined the impact of
uncontrolled hypertension on health-related quality of
life, expressed as deteriorated functional capacity,
affected vitality and impaired mental health. There is
less evidence to support the negative effect of high
levels of blood cholesterol with dimensions of quality of
life, especially in the setting of essential hypertension
(Katsi et al. 2010). In our study, hypertensive patients
with coexisting dyslipidaemia
reported marginally
lower levels in different aspects of HRQoL as physical
functioning, physical role, vitality, bodily pain, and
general health, whereas we didn’t find significant
differences in terms of mental health, social functioning
and emotional role. This could imply that dyslipidaemia
are prone to affect specific dimensions related with
more biological factors. It is possible that patients with
combined
morbidity
with
hypertension
and
dyslipidaemia, as they represent a group in higher risk,
are characterized with more extended cardiovascular
complications (Catapano et al. 2011).
However, it seems to exist something like a paradox
phenomenon in our results. Albeit the association
between the dyslipidaemia and quality of life is limited
to the physical components, when we compared the
psychopathology between the two groups, statistical
significant differences were found. More analytically,
we observed higher levels of somatization, obsessivecompulsive, interpersonal sensitivity, depression,
anxiety, paranoid ideation and psychoticism. An
explanation to this paradox could be that the chronic
burden of the disease create an emotional response
accompanied by negative thoughts, self-criticism and
psychological distress. This is consistent with
published evidence (Spruill et al. 2013; Mena-Martin et
al. 2003).
In order to further investigate this association we
performed logistic regression analysis. We found that
only physical role, vitality and physical component
summary remain significant after adjustments.
Especially lowering levels of blood cholesterol tend to
raise vitality and reduce levels of anxiety and paranoid
ideation. On the other hand, higher levels of
dyslipidaemia produce higher levels of somatization
and interpersonal sensitivity. A remarkable finding is
that dyslipidaemia is strongly associated with
avoidance behavior. Specifically hypertensives with
high levels of cholesterol demonstrate 8-fold higher
rates of avoidance compared with normolipidaemichypertensive patients. This is in accordance
with the work of Lalonde et al, where diagnosis of
dyslipidaemia
in
asymptomatic
patients
is
accompanied with reduction in HRQoL. Presumably
this phenomenon could be produced because they
adopt the perception of illness (Lalonde et al. 2001).
However due to the wide confidence intervals the later
should be considered with caution.
One limitation of this study is the cross-sectional
design which minimizes the causal association among
variables. However our results illustrate the
aggravating role of dylipidaemia in the setting of
essential hypertension and outline the need of a more
multidisciplinary therapeutic approach in this group of
patients.
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133
Tables
Table 1 Demographic characteristics and clinical parameters of the two groups and the whole sample
Variables
Mean age in years(±SD)
Gender
Men
Women
Marital Status
Single
Married
Divorced
Widowed
COPD
Yes
No
Smoking
Yes
No
Impaired glucose tolerance
Yes
No
Duration in mo. (mean ± SD)
Dipping Status (n=189)
Dippers
No Dippers
Reverse Dippers
LV Hypertrophy (n=189)
Yes
No
Renal Failure (n=189)
Yes
No
Stroke (n=189)
Yes
No
Intima Media Thickness
(n=188)
Yes
No
Dyslipidaemic
hypertensive
patients
(n=121)
54.8±10.4
Non- Dyslipidaemic
hypertensive patients
(n=76)
Total (n=197)
49.9±13.4
53±12
48 (39.7%)
73 (60.3%)
40 (53.3%)
36 (46.7%)
88 (44.6%)
109 (55.4%)
24 (19.8%)
88 (72.7%)
8 (6.6%)
1 (0.8%)
24 (32.0%)
52 (68.0%)
0 (0.0%)
0 (0.0%)
48 (24.4%)
140 (71.1%)
8 (4.1%)
1 (.5%)
6 (5.0%)
115 (95.0%)
1(1.3%)
75 (98.7%)
7 (3.6%)
190 (96.4%)
64 (52.9%)
57 (47.1%)
25 (33.3%)
51 (66.7%)
89 (45.2%)
108 (54.8%)
15 (12.4%)
106 (87.6%)
29.2±43.3
7 (9.3%)
69 (90.7%)
24.7±35.8
22 (11.2%)
175 (88.8%)
27.5±40
84 (69.4%)
31 (25.6%)
6 (5.0%)
42 (56.0%)
20 (26.7%)
6 (8.0%)
126 (64%)
51 (29.9%)
12 (6.1%)
49 (40.5%)
72 (59.5%)
23 (30.7%)
45 (60.5%)
72 (36.5%)
117(59.4%)
6 (5.0%)
115 (95.0%)
3 (1.9%)
65 (86.7%)
9 (4.6%)
180 (92.9%)
4(3.3%)
117 (96.7%)
2 (2.7%)
66 (88.0%)
6 (3.0%)
183 (92.9%)
Dyslipidaemicvs.
NonDyslipidaemic
p=.004
p=.062
p=.008
p=.184
p=.012
p=.643
p=.532
p=.430
p=.630
p=.969
p=.891
p=.414
41 (33.9%)
80 (66.1%)
17 (22.7%)
50 (66.7%)
58 (29.4%)
130 (66.0%)
COPD= Chronic Obstructive Pulmonary Disease
134
Table 2 Means and standard deviations for psychometric variables
Variables
Groups
PhysicalFunctioning
(PF)
Dyslipidaemic
Non- Dyslipidaemic
121
76
79.04
85.76
19.08
16.30
Role -Physical (RP)
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
121
76
121
76
67.98
76.62
69.28
69.13
38.51
34.05
35.85
37.77
p=.046
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
121
76
121
76
59.81
69.50
65.78
67.38
21.00
18.01
19.11
17.68
p=.000
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
121
76
121
76
121
76
121
76
73.31
78.81
72.56
80.94
54.57
62.15
68.30
76.37
23.84
22.50
24.82
23.09
17.92
16.63
19.43
17.49
p=.051
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
121
76
121
76
121
76
121
76
121
76
121
67.11
71.21
12.24
7.42
10.94
7.60
8.11
5.92
12.56
8.51
7.69
19.94
19.11
8.51
6.02
6.77
6.14
5.79
4.63
8.81
6.92
7.37
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
Dyslipidaemic
Non- Dyslipidaemic
76
121
76
121
76
121
76
121
76
121
76
121
76
121
76
121
76
5.62
4.69
3.91
2.37
2.11
6.60
5.28
5.79
4.38
1.262
1.63
1.333
.952
.744
.603
1.10
1.08
4.94
3.61
4.38
3.08
2.74
4.99
4.70
4.96
3.69
1.03
1.02
.83
.80
.60
.49
.56
.46
Role-Emotional (RE)
Vitality (VT)
Mental Health (MH)
Social Functioning (SF)
BodilyPain (BP)
General Health (GH)
PhysicalComponentSumm
ary (PCS)
MentalComponentSumm
ary (MCS)
Somatization
Obsessive-compulsive
Interpersonalsensitivity
Depression
Anxiety
N
Mean
SD
Dyslipidaemic vs.
Non- Dyslipidaemic
p=.001
p=.973
p=.473
p=.004
p=.000
p=.000
p=.084
p=.000
p=.000
p=.001
p=.000
p=.004
Hostility
Phobicanxiety
Paranoidideation
Psychoticism
Fear
Avoidance
Heart Focused Attention
Total CAQ
p=.097
p=.472
p=.025
p=.010
p=.059
p=.017
p=.196
p=.848
CAQ= Cardiac Anxiety Questionnaire
135
Variables
Table 3Logistic Regression analysis of demographic and psychometric variables
Wald
P value
Odds ratio (95%
Confidence Interval)
Age
.016
p>.05
0.996 (.98-1.01)
Marital status
.120
p>.05
1.043 (.89-1.21)
Smoking
.063
p>.05
1.066 (.97-1.06)
Physical Functioning
(PF)
Role -Physical (RP)
.003
p>.05
1.002(.94-1.06)
10.179
p < .001
1.065 (1.03-1.11)
5.686
p < .01
-.939 (.89-.98)
BodilyPain (BP)
.215
p>.05
1.010 (.97-1.05)
General Health (GH)
.263
p>.05
.983 (.92-1.049)
PhysicalComponentSum
mary (PCS)
9.485
p < .01
1.013 (1.05-1.39)
Somatization
13.130
p < .001
1.604 (1.24-2.07)
.448
p>.05
1.068 (.88-1.29)
5.121
p < .01
1.371 (1.04-1.80)
.114
p>.05
1.045 (.80-1.35)
Anxiety
4.618
p < .05
-.723 (.54-.97)
Paranoidideation
5.369
p < .05
-.721 (.55-.95)
.003
p>.05
1.009 (.75-1.35)
16.034
p < .001
8.706 (1.54-4.93)
Vitality (VT)
Obsessive-compulsive
Interpersonalsensitivity
Depression
Psychoticism
Avoidance
Methods=Enter
136

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